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General NPI Number Information
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NPI Number | 1194934778
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Entity Type | Organization
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Legal Business Name | BONNER ENDODONTIC CENTER
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 5756 S STAPLES ST A-2
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City | CORPUS CHRISTI
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State | TX
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Zip | 78413-3782
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Country | US
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Telephone | 361-993-3199
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Fax | 361-993-2712
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Provider Business Mailing Address
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Address Line | 5756 S STAPLES ST A-2
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City | CORPUS CHRISTI
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State | TX
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Zip | 78413-3782
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Country | US
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Telephone | 361-993-3199
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Fax | 361-993-2712
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANK EDMUND BONNER JR.
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Credential | DDS
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Telephone | 361-993-3100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 19302
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License Number State | TX
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