Provider Demographics
NPI:1598812208
Name:BONAR, VICTORIA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:A
Last Name:BONAR
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 LIBERTY ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-2450
Mailing Address - Country:US
Mailing Address - Phone:503-581-4675
Mailing Address - Fax:503-581-7279
Practice Address - Street 1:810 LIBERTY ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-2450
Practice Address - Country:US
Practice Address - Phone:503-581-4675
Practice Address - Fax:503-581-7279
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR64231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice