Individual
DR. LARRY ROSS BUNTYN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
14070 DEDEAUX RD, GULFPORT, MS 39503-4502
(228) 832-1951
(228) 832-5558
Mailing address
14070 DEDEAUX RD, GULFPORT, MS 39503-4502
(228) 832-1951
(228) 832-5558
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1228-67
MS
Other
Enumeration date
10/04/2006
Last updated
07/08/2007
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