Provider Demographics
NPI:1225537327
Name:STELLA BONDAR DMD PC
Entity Type:Organization
Organization Name:STELLA BONDAR DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STELLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BONDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-472-1287
Mailing Address - Street 1:1261 FURNACE BROOK PKWY STE 27
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-4762
Mailing Address - Country:US
Mailing Address - Phone:617-472-1287
Mailing Address - Fax:617-472-1288
Practice Address - Street 1:1261 FURNACE BROOK PKWY STE 27
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4762
Practice Address - Country:US
Practice Address - Phone:617-472-1287
Practice Address - Fax:617-472-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-05
Last Update Date:2018-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19975261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental