Provider Demographics
NPI:1043297351
Name:BUNCH, KRISTINA L (DDS)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:L
Last Name:BUNCH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 GEORGE WASHINGTON WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-4247
Mailing Address - Country:US
Mailing Address - Phone:509-946-1678
Mailing Address - Fax:509-946-7500
Practice Address - Street 1:750 GEORGE WASHINGTON WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4247
Practice Address - Country:US
Practice Address - Phone:509-946-1678
Practice Address - Fax:509-946-7500
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000064061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9993OtherDELTA
WA219274OtherBCBS VIRGINIA
WA5010491Medicaid