Provider Demographics
NPI:1003026998
Name:BONADEO, DAVID CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:BONADEO
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:G3280 S GRAND TRAVERSE ST
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48529-1152
Mailing Address - Country:US
Mailing Address - Phone:810-744-4400
Mailing Address - Fax:810-744-1314
Practice Address - Street 1:G3280 S GRAND TRAVERSE ST
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48529-1152
Practice Address - Country:US
Practice Address - Phone:810-744-4400
Practice Address - Fax:810-744-1314
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011889122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901011889OtherBOARD OF DENTISTRY LIC.