Healthcare Provider Details

I. General information

NPI: 1164920286
Provider Name (Legal Business Name): BONDURANT DENTAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MAIN ST NE
BONDURANT IA
50035-7722
US

IV. Provider business mailing address

108 MAIN ST NE
BONDURANT IA
50035-7722
US

V. Phone/Fax

Practice location:
  • Phone: 515-967-4002
  • Fax:
Mailing address:
  • Phone: 515-967-4002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVEN NEVILLE
Title or Position: DDS/BUSINESS OWNER
Credential: DDS
Phone: 515-967-4002