Provider Demographics
NPI:1740413467
Name:BONITA CLEMENTE DELA RAMA, DDS INC.
Entity Type:Organization
Organization Name:BONITA CLEMENTE DELA RAMA, DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:CLEMENTE
Authorized Official - Last Name:DELA RAMA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:650-878-0651
Mailing Address - Street 1:980 KING PLZ
Mailing Address - Street 2:SUITE #1
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-4450
Mailing Address - Country:US
Mailing Address - Phone:650-878-0651
Mailing Address - Fax:
Practice Address - Street 1:980 KING PLZ
Practice Address - Street 2:SUITE #1
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-4450
Practice Address - Country:US
Practice Address - Phone:650-878-0651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA314481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB31448-01OtherDENTICAL