Provider Demographics
NPI:1609977743
Name:BONNER, LESLIE EUGENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:EUGENE
Last Name:BONNER
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 1:1700 17TH ST NW
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2453
Mailing Address - Country:US
Mailing Address - Phone:202-249-9131
Mailing Address - Fax:202-249-2851
Practice Address - Street 1:1700 17TH ST NW
Practice Address - Street 2:SUITE 302
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2453
Practice Address - Country:US
Practice Address - Phone:202-249-9131
Practice Address - Fax:202-249-2851
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN 5997122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist