MEDICARE: D.C. BONADEO, D.D.S., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	2901011889	MI

General Provider Information

NPI Number	:	1699985598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	D.C. BONADEO, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	751 CHESTNUT ST
Second Line	:	SUITE 101
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-6461
Country	:	US
Telephone Number	:	248-647-2109
Fax Number	:	248-647-1804

Provider Business Practice Location Address
First Line	:	751 CHESTNUT ST
Second Line	:	SUITE 101
City	:	BIRMINGHAM
State	:	MI
Zip	:	48009-6461
Country	:	US
Telephone Number	:	248-647-2109
Fax Number	:	248-647-1804

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID CHARLES BONADEO
Credential	:	D.D.S.
Telephone Number	:	248-647-2109

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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