Provider Demographics
NPI:1205087020
Name:DAVIDSON, BONITA TURNER (DMD)
Entity type:Individual
Prefix:DR
First Name:BONITA
Middle Name:TURNER
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BRANDON RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3631
Mailing Address - Country:US
Mailing Address - Phone:865-765-4970
Mailing Address - Fax:
Practice Address - Street 1:124 BRANDON RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3631
Practice Address - Country:US
Practice Address - Phone:865-765-4970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist