Provider Demographics
NPI:1053665695
Name:EVA BODONI DDS PROFESSIONAL LLC
Entity Type:Organization
Organization Name:EVA BODONI DDS PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EVA
Authorized Official - Middle Name:
Authorized Official - Last Name:BODONI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-221-1588
Mailing Address - Street 1:8000 E PRENTICE AVE
Mailing Address - Street 2:SUITE B-7
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2744
Mailing Address - Country:US
Mailing Address - Phone:303-221-1588
Mailing Address - Fax:
Practice Address - Street 1:8000 E PRENTICE AVE
Practice Address - Street 2:SUITE B-7
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2744
Practice Address - Country:US
Practice Address - Phone:303-221-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty