Provider Demographics
NPI:1780965046
Name:BONANDER, JEREMY R (DDS)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:R
Last Name:BONANDER
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1370 N SILVERBELL RD STE 140
Mailing Address - Street 2:#178
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2290
Mailing Address - Country:US
Mailing Address - Phone:208-559-6122
Mailing Address - Fax:530-300-7330
Practice Address - Street 1:716 N COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716
Practice Address - Country:US
Practice Address - Phone:208-559-6122
Practice Address - Fax:530-300-7330
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0088611223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology