Provider Demographics
NPI:1669551834
Name:BONDRA, DANIEL LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:BONDRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:201 S MCPHERSON CHURCH RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303
Mailing Address - Country:US
Mailing Address - Phone:910-485-3636
Mailing Address - Fax:910-222-9401
Practice Address - Street 1:201 S MCPHERSON CHURCH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303
Practice Address - Country:US
Practice Address - Phone:910-485-3636
Practice Address - Fax:910-222-9401
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC708042OtherUNITED CONCORDIA
NC899000TMedicaid
NC9000TOtherBCBS