Provider Demographics
NPI:1154612182
Name:MCCLEARY, BONNIE LEE (CDA, RDA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEE
Last Name:MCCLEARY
Suffix:
Gender:F
Credentials:CDA, RDA
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:LEE
Other - Last Name:POLAMBI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 VILLINGER AVE
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-2933
Mailing Address - Country:US
Mailing Address - Phone:856-785-0123
Mailing Address - Fax:
Practice Address - Street 1:1 BRITTON PL
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2514
Practice Address - Country:US
Practice Address - Phone:856-785-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DP00517600126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant