Provider Demographics
NPI:1861433658
Name:BUNTEMEYER, CRAIG E (DDS)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:E
Last Name:BUNTEMEYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9113 S TOLEDO AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2719
Mailing Address - Country:US
Mailing Address - Phone:918-743-9275
Mailing Address - Fax:918-743-9279
Practice Address - Street 1:9113 S TOLEDO AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74137-2719
Practice Address - Country:US
Practice Address - Phone:918-743-9275
Practice Address - Fax:918-743-9279
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3986122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist