Provider Demographics
NPI:1487427985
Name:BUNDY, DENNIS DEAN JR
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:DEAN
Last Name:BUNDY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15956 MOUNTAIN VIEW LN
Mailing Address - Street 2:
Mailing Address - City:LA PINE
Mailing Address - State:OR
Mailing Address - Zip Code:97739-9749
Mailing Address - Country:US
Mailing Address - Phone:541-647-4262
Mailing Address - Fax:
Practice Address - Street 1:23 NW GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-2078
Practice Address - Country:US
Practice Address - Phone:541-383-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)