Individual
DR. JERRY LEE BONDURANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1900 SCHOOL ST, KANAWHA DENTAL HEALTH COUNCIL INC, CHARLESTON, WV 25312-1524
(304) 348-6613
Mailing address
314 SOUTH ST, SO CHARLESTON, WV 25303-1823
(304) 744-6962
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
1980
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012835000
—
WV
05
—
0133364000
—
WV
Enumeration date
03/09/2007
Last updated
07/09/2007
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