Provider Demographics
NPI:1164920286
Name:BONDURANT DENTAL CENTER
Entity Type:Organization
Organization Name:BONDURANT DENTAL CENTER
Other - Org Name:BONDURANT FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS/BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-967-4002
Mailing Address - Street 1:108 MAIN ST NE
Mailing Address - Street 2:
Mailing Address - City:BONDURANT
Mailing Address - State:IA
Mailing Address - Zip Code:50035-7722
Mailing Address - Country:US
Mailing Address - Phone:515-967-4002
Mailing Address - Fax:
Practice Address - Street 1:108 MAIN ST NE
Practice Address - Street 2:
Practice Address - City:BONDURANT
Practice Address - State:IA
Practice Address - Zip Code:50035-7722
Practice Address - Country:US
Practice Address - Phone:515-967-4002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental