Individual
DR. LECHANDRE BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 BARRETT PKWY STE 4060, KENNESAW, GA 30144-4949
(678) 905-6300
(678) 905-6301
Mailing address
2019 CLOVERCROFT RD NW, ACWORTH, GA 30101-7178
(706) 627-9079
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN012435
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000946536AP
—
GA
05
—
000946536C
—
GA
05
—
000946536L
—
GA
Enumeration date
11/14/2006
Last updated
05/13/2019
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