Provider Demographics
NPI:1366882367
Name:BONNER, STELLA P (DMD)
Entity type:Individual
Prefix:DR
First Name:STELLA
Middle Name:P
Last Name:BONNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 HICKORY ST
Mailing Address - Street 2:APT. 6108
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1880
Mailing Address - Country:US
Mailing Address - Phone:706-284-9256
Mailing Address - Fax:
Practice Address - Street 1:500 SOUTH WALL ST.
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701
Practice Address - Country:US
Practice Address - Phone:706-602-9255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0145781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice