# BONNEY LAKE FAMILY DENTISTRY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bonney Lake Family Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548018526
- **Authorized official:** NICK SUNDIAM (CREDENTIALING MANAGER)
- **Authorized official phone:** (719) 300-5933

## Contact information

- **Practice address:** 21515 STATE ROUTE 410 E STE A, BONNEY LAKE, WA 98391-4100
- **Practice address phone:** (253) 826-9000
- **Practice address fax:** (253) 826-0328
- **Mailing address:** 21515 STATE ROUTE 410 E STE A, BONNEY LAKE, WA 98391-4100
- **Mailing address phone:** (253) 826-9000
- **Mailing address fax:** (253) 826-0328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 05/07/2024
- **Last updated:** 05/07/2024