Bubble Gum Kids Dentistry

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

BUBBLE GUM KIDS DENTISTRY

Doing business as

Bubble Gum Kids Dentistry

Practice address

460
Port Huron, MI 48060

Phone

(810) 984-5437

Fax

(810) 987-9499

NPI assigned

Jun 26, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Amy Paundlay

Title

Sr. Vice President of Operation

Phone

(203) 400-9999

Specialties & licenses 1

Addresses

Other names 1

• Bubble Gum Kids Dentistry Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1285310128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "460",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "810-984-5437",
            "fax_number": "810-987-9499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "48060",
            "telephone_number": "810-984-5437",
            "fax_number": "810-987-9499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUBBLE GUM KIDS DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-26",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A",
        "authorized_official_last_name": "PAUNDLAY",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "SR. VICE PRESIDENT OF OPERATION",
        "authorized_official_telephone_number": "203-400-9999",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bubble Gum Kids Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Thomas Francis Brozovich, D.O.
• Kristi Allyn Bruinsma
• Stephanie L Bryce
• Jamie Bryer
• Kayla Brynaert, LMSW
• Diane Marie Bubel, RN
• Budget Optical Inc
• Budget Optical Inc
• Budget Optical Inc
• Lester Buhler, M.D.

• Pediatric Dentistry in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Pediatric Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.