Bonney Lake Family Dentistry, Pllc
NPI #1548018526 in Bonney Lake, Washington
Provider Information
- NPI Number
- 1548018526
- Entity Type
- Organization
- Organization Name
- Bonney Lake Family Dentistry, Pllc
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- May 7, 2024
- Last Updated
- May 7, 2024
Practice Location
- Address
- 21515 STATE ROUTE 410 E STE A
- City
- Bonney Lake
- State
- Washington
- ZIP Code
- 98391-4100
- Phone
- (253) 826-9000
Authorized Official
- Name
- NICK SUNDIAM
- Title
- CREDENTIALING MANAGER
- Phone
- (719) 300-5933
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
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