Individual
DR. BONNIE L PADWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD, MD
Contact information
Practice address
300 LONGWOOD AVE, HU-158, BOSTON, MA 02115-5724
(617) 355-6259
(617) 738-1657
Mailing address
300 LONGWOOD AVE, HU-158, BOSTON, MA 02115-5724
(617) 355-6259
(617) 738-1657
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
17008
MA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
75473
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3101207
—
MA
01
—
730778
TUFTS HEALTH PLAN
MA
01
—
J13074
BCBS MA
MA
Enumeration date
10/27/2005
Last updated
10/21/2008
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