Provider Demographics
NPI:1346518156
Name:DAVID M. BONNER, D.D.S., P.C.
Entity Type:Organization
Organization Name:DAVID M. BONNER, D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MAL
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-935-6811
Mailing Address - Street 1:101 BINKLEY
Mailing Address - Street 2:
Mailing Address - City:DUMAS
Mailing Address - State:TX
Mailing Address - Zip Code:79029
Mailing Address - Country:US
Mailing Address - Phone:806-935-6811
Mailing Address - Fax:806-935-9080
Practice Address - Street 1:101 BINKLEY
Practice Address - Street 2:
Practice Address - City:DUMAS
Practice Address - State:TX
Practice Address - Zip Code:79029
Practice Address - Country:US
Practice Address - Phone:806-935-6811
Practice Address - Fax:806-935-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12414122300000X
TX27086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty