Provider Demographics
NPI:1700267846
Name:BODNER AND BODNER- BRANFORD
Entity Type:Organization
Organization Name:BODNER AND BODNER- BRANFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GEREON
Authorized Official - Last Name:BODNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-481-2509
Mailing Address - Street 1:365 EAST MAIN STREET
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-2913
Mailing Address - Country:US
Mailing Address - Phone:203-481-2509
Mailing Address - Fax:
Practice Address - Street 1:365 EAST MAIN STREET
Practice Address - Street 2:SUITE #2
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-2913
Practice Address - Country:US
Practice Address - Phone:203-481-2509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT70861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty