Organization
BONNEY LAKE FAMILY DENTISTRY, PLLC
Active
Other names
Bonney Lake Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
NICK SUNDIAM (CREDENTIALING MANAGER)
(719) 300-5933
Entity
Organization
Contact information
Practice address
21515 STATE ROUTE 410 E STE A, BONNEY LAKE, WA 98391-4100
(253) 826-9000
(253) 826-0328
Mailing address
21515 STATE ROUTE 410 E STE A, BONNEY LAKE, WA 98391-4100
(253) 826-9000
(253) 826-0328
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
05/07/2024
Last updated
05/07/2024
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