Provider Demographics
NPI:1053524918
Name:TEODORA T. BONNEY, DMD. PC
Entity type:Organization
Organization Name:TEODORA T. BONNEY, DMD. PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TEODORA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BONNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:717-731-3466
Mailing Address - Street 1:133 S. 32ND STREET
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-731-3466
Mailing Address - Fax:888-415-3908
Practice Address - Street 1:133 S. 32ND STREET
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-731-3466
Practice Address - Fax:888-415-3908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029483L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA966686Medicare UPIN