Provider Demographics
NPI:1811736457
Name:TUCSON DENTAL ANESTHESIA PLLC
Entity type:Organization
Organization Name:TUCSON DENTAL ANESTHESIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-559-6122
Mailing Address - Street 1:1370 N SILVERBELL RD STE #140
Mailing Address - Street 2:PMB #178
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745
Mailing Address - Country:US
Mailing Address - Phone:208-559-6122
Mailing Address - Fax:
Practice Address - Street 1:6422 E SPEEDWAY BLVD STE 140
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1148
Practice Address - Country:US
Practice Address - Phone:208-559-6122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDental AnesthesiologyGroup - Single Specialty