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General NPI Number Information
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NPI Number | 1811736457
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Entity Type | Organization
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Legal Business Name | TUCSON DENTAL ANESTHESIA PLLC
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 6422 E SPEEDWAY BLVD STE 140
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City | TUCSON
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State | AZ
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Zip | 85710-1148
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Country | US
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Telephone | 208-559-6122
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Fax |
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Provider Business Mailing Address
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Address Line | 1370 N SILVERBELL RD STE #140 PMB #178
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City | TUCSON
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State | AZ
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Zip | 85745
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Country | US
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Telephone | 208-559-6122
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JEREMY BONANDER
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Credential | DDS
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Telephone | 208-559-6122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0004X
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Taxonomy Name | Dental Anesthesiology
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License Number |
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License Number State |
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