Provider Demographics
NPI:1275579070
Name:NONDORF, MICHAEL CHARLES (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:CHARLES
Last Name:NONDORF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 E COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:TX
Mailing Address - Zip Code:78945-2243
Mailing Address - Country:US
Mailing Address - Phone:979-968-9451
Mailing Address - Fax:979-968-8608
Practice Address - Street 1:279 E COLORADO ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:TX
Practice Address - Zip Code:78945-2243
Practice Address - Country:US
Practice Address - Phone:979-968-9451
Practice Address - Fax:979-968-8608
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist