Healthcare Provider Details

I. General information

NPI: 1992193726
Provider Name (Legal Business Name): RONA BODMAN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2015
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

899 N WILMOT RD BLDG E
TUCSON AZ
85711-1714
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-616-1542
  • Fax: 520-616-1537
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-616-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: