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General NPI Number Information
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NPI Number | 1477817690
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Entity Type | Individual
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Provider Name | STEPHANIE A BODNAR DMD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2012
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | FRIENDLY DENTAL CENTER 604 MARKET ST #3A
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City | NEWARK
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State | NJ
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Zip | 07105
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Country | US
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Telephone | 973-465-8885
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Fax |
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Provider Business Mailing Address
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Address Line | 4300 S BEACH PKWY APT. 3208
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City | JACKSONVILLE BEACH
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State | FL
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Zip | 32250-8173
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Country | US
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Telephone | 201-919-8624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 19840
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License Number State | FL
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