Provider Demographics
NPI:1891957544
Name:DAVID W BONDERER DDS PLLC
Entity Type:Organization
Organization Name:DAVID W BONDERER DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEDE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONDERER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-497-2424
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553
Mailing Address - Country:US
Mailing Address - Phone:228-497-2424
Mailing Address - Fax:228-497-0621
Practice Address - Street 1:2808 HWY 90
Practice Address - Street 2:SUITE 1
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553
Practice Address - Country:US
Practice Address - Phone:228-497-2424
Practice Address - Fax:228-497-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS163974122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty