Provider Demographics
NPI:1881181030
Name:NATHAN C. DEWSNUP DMD, MS, LLC
Entity Type:Organization
Organization Name:NATHAN C. DEWSNUP DMD, MS, LLC
Other - Org Name:BONITA ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:CANNON
Authorized Official - Last Name:DEWSNUP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:239-498-7668
Mailing Address - Street 1:8899 TIMBERWILDE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7896
Mailing Address - Country:US
Mailing Address - Phone:239-498-7668
Mailing Address - Fax:239-498-7630
Practice Address - Street 1:8899 TIMBERWILDE DR STE 3
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7896
Practice Address - Country:US
Practice Address - Phone:239-498-7668
Practice Address - Fax:239-498-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-13
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN223681223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty