Healthcare Provider Details

I. General information

NPI: 1285035865
Provider Name (Legal Business Name): DR. STELLA BONDAR D.M.D.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 FURNACE BROOK PKWY STE 27
QUINCY MA
02169
US

IV. Provider business mailing address

1261 FURNACE BROOK PKWY STE 27
QUINCY MA
02169
US

V. Phone/Fax

Practice location:
  • Phone: 617-472-1287
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19975
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19975
License Number StateMA

VIII. Authorized Official

Name: MRS. MARIE COLLINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 617-472-1287