Provider Demographics
NPI:1194934778
Name:BONNER ENDODONTIC CENTER
Entity type:Organization
Organization Name:BONNER ENDODONTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:EDMUND
Authorized Official - Last Name:BONNER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:361-993-3100
Mailing Address - Street 1:5756 S STAPLES ST
Mailing Address - Street 2:A-2
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-3782
Mailing Address - Country:US
Mailing Address - Phone:361-993-3199
Mailing Address - Fax:361-993-2712
Practice Address - Street 1:5756 S STAPLES ST
Practice Address - Street 2:A-2
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-3782
Practice Address - Country:US
Practice Address - Phone:361-993-3199
Practice Address - Fax:361-993-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty