Provider Demographics
NPI:1801595210
Name:BONITA ENDODONTIC ASSOCIATES, PLLC
Entity type:Organization
Organization Name:BONITA ENDODONTIC ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:DEWSNUP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:239-498-7668
Mailing Address - Street 1:8899 TIMBERWILDE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7896
Mailing Address - Country:US
Mailing Address - Phone:239-498-7668
Mailing Address - Fax:239-498-7630
Practice Address - Street 1:8899 TIMBERWILDE DR STE 3
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7896
Practice Address - Country:US
Practice Address - Phone:239-498-7668
Practice Address - Fax:239-498-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN16186OtherFLORIDA BOARD OF DENTISTRY
FLDN22368OtherFLORIDA BOARD OF DENTISTRY
FLDN21501OtherFLORIDA BOARD OF DENTISTRY
FLDN27423OtherFLORIDA BOARD OF DENTISTRY