Provider Demographics
NPI:1669527750
Name:BONDURANT, ROBERT CHRISTOPHER (DMD, MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHRISTOPHER
Last Name:BONDURANT
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27587 US HIGHWAY 98
Mailing Address - Street 2:
Mailing Address - City:DAPHNE
Mailing Address - State:AL
Mailing Address - Zip Code:36526-4839
Mailing Address - Country:US
Mailing Address - Phone:251-621-6616
Mailing Address - Fax:
Practice Address - Street 1:27587 US HIGHWAY 98
Practice Address - Street 2:
Practice Address - City:DAPHNE
Practice Address - State:AL
Practice Address - Zip Code:36526-4839
Practice Address - Country:US
Practice Address - Phone:251-621-6616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4285174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL740284OtherUNITED CONCORDIA
AL51035587OtherBLUE CROSS BLUE SHIELD AL
AL740284OtherUNITED CONCORDIA