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General NPI Number Information
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NPI Number | 1619591393
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Entity Type | Organization
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Legal Business Name | ADVANCED PERIODONTICS & IMPLANT CARE, LLC
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Dates
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Enumeration Date | 05/29/2020
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Last Update Date | 05/29/2020
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Provider Practice Location Address
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Address Line | 1950 LAUREL MANOR DRIVE #184
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City | THE VILLAGES
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State | FL
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Zip | 32162
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Country | US
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Telephone | 352-750-4075
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Fax | 352-750-8072
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Provider Business Mailing Address
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Address Line | 1950 LAUREL MANOR DRIVE #184
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City | THE VILLAGES
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State | FL
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Zip | 32162
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Country | US
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Telephone | 352-750-4075
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Fax | 352-750-8072
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN WALTER BONNER
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Credential | D.D.S.
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Telephone | 352-750-4075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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