Provider Demographics
NPI:1235593740
Name:DOBBS, BONNER
Entity Type:Individual
Prefix:
First Name:BONNER
Middle Name:
Last Name:DOBBS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8751 FERNDALE RD APT 153
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75238-3511
Mailing Address - Country:US
Mailing Address - Phone:469-878-9148
Mailing Address - Fax:
Practice Address - Street 1:8751 FERNDALE RD APT 153
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-3511
Practice Address - Country:US
Practice Address - Phone:469-878-9148
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist