Diane Stenson Bundy, DDS
Individual provider Active NPI General Practice Dentistry · Thomasville, NC
NPI 1619002466 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1619002466
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 6473 (NC)
- Practice address
- 210 Arthur Dr
Thomasville, NC 27360-6275 - Phone
- (336) 476-6129
- Fax
- (336) 476-3254
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150728004790 | NC | Order and Referring Only - Dentist |
4688988173 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Smith, Lanning & Bundy | General Practice | Past | Accepting new patients |
| Smith Bundy and Fisher | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6473 | NC | Yes |
Addresses
Primary practice location
210 Arthur Dr
Thomasville, NC 27360-6275
Mailing address
210 Arthur Dr
Thomasville, NC 27360-6275
Phone (336) 476-6129
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8998080 | Medicaid | NC |
Other providers in Thomasville, NC
- Athena C Brummett
- Jessica Bruno
- Jonathan S Bryson
- Joy Sabrina Moses Buford
- Taylor Evans Bulla
- Daniel F Burks
- Sharda Nirmala Busse
- Allison Renee Butler
- Kariah Makayla Butler
- Julia Byron
All providers in Thomasville, NC · General Practice Dentistry in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.