Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901011889 | MI |
NPI | 1003026998 |
---|---|
Provider Name | Dr. David Charles Bonadeo |
First Address | Burton, MI 48529-1152 |
Second Address | Burton, MI 48529-1152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2901011889 | BOARD OF DENTISTRY LIC. (01) | MI |