Provider Demographics
NPI:1649306234
Name:BODNER, ARTHUR D (DMD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:D
Last Name:BODNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3525 PIEDMONT RD NE STE 420
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1578
Mailing Address - Country:US
Mailing Address - Phone:404-261-3091
Mailing Address - Fax:404-261-0048
Practice Address - Street 1:2339 PEACHTREE RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-4147
Practice Address - Country:US
Practice Address - Phone:404-233-1547
Practice Address - Fax:404-233-0991
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0071351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000336476AMedicaid