Provider Demographics
NPI:1962551523
Name:VONDRA, ANTHONY JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:JOHN
Last Name:VONDRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15672 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116
Mailing Address - Country:US
Mailing Address - Phone:402-572-4180
Mailing Address - Fax:402-991-5874
Practice Address - Street 1:15672 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116
Practice Address - Country:US
Practice Address - Phone:402-572-4180
Practice Address - Fax:402-991-5874
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9005122300000X
NE6929122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist