Provider Demographics
NPI:1083301402
Name:BONATIDUDLEY PLLC
Entity Type:Organization
Organization Name:BONATIDUDLEY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CDO
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GIGGEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-875-8896
Mailing Address - Street 1:400 W SOUTH BOULDER RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-2724
Mailing Address - Country:US
Mailing Address - Phone:303-875-8896
Mailing Address - Fax:
Practice Address - Street 1:4855 WARD RD STE 700
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-1953
Practice Address - Country:US
Practice Address - Phone:303-422-8748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PDS-BONATI LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-04-18
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental