# BUNCH-GORMAN, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Innovative Orthodontics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1982925905
- **Authorized official:** JASON K BUNCH D.D.S., M.S. (ORTHODONTIST/ CO-OWNER)
- **Authorized official phone:** (765) 459-3145

## Contact information

- **Practice address:** 1926 S DIXON RD, KOKOMO, IN 46902-7302
- **Practice address phone:** (765) 459-3145
- **Practice address fax:** (765) 459-4048
- **Mailing address:** 1926 S DIXON RD, KOKOMO, IN 46902-7302
- **Mailing address phone:** (765) 459-3145
- **Mailing address fax:** (765) 459-4048

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | 12010651A | IN | Yes |
| 261QD0000X | Dental Clinic/Center | 8906IN | IN | — |

## Other

- **Enumeration date:** 06/14/2010
- **Last updated:** 06/14/2010