Provider Demographics
NPI:1831293562
Name:BONCORDO, ANTONIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:
Last Name:BONCORDO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 1/2 ALBANY SHAKER RD
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211
Mailing Address - Country:US
Mailing Address - Phone:518-458-1320
Mailing Address - Fax:518-458-9670
Practice Address - Street 1:515 1/2 ALBANY SHAKER RD
Practice Address - Street 2:
Practice Address - City:LOUDONVILLE
Practice Address - State:NY
Practice Address - Zip Code:12211
Practice Address - Country:US
Practice Address - Phone:518-458-1320
Practice Address - Fax:518-458-9670
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04605011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice