Provider Demographics
NPI:1083750939
Name:DOVE, BONNIE L (RDH)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:DOVE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:MD
Mailing Address - Zip Code:21636-1126
Mailing Address - Country:US
Mailing Address - Phone:410-634-2380
Mailing Address - Fax:833-916-1014
Practice Address - Street 1:316 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:MD
Practice Address - Zip Code:21636-1126
Practice Address - Country:US
Practice Address - Phone:410-634-2380
Practice Address - Fax:833-916-1014
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1637124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist