Lechandre Bonner

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012435 Issued in GA

Practice address

425 Barrett Pkwy Ste 4060
Kennesaw, GA 30144-4949

Phone

(678) 905-6300

Fax

(678) 905-6301

NPI assigned

Nov 14, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Lechandre Wadley Other name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: info@floss365dental.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Newberry Institute

  • Dental Clinic/Center
  • Hawkinsville, GA
  • NPI 1376400135
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557705600000",
    "number": "1114099348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2019 CLOVERCROFT RD NW",
            "city": "ACWORTH",
            "state": "GA",
            "postal_code": "301017178",
            "telephone_number": "706-627-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 BARRETT PKWY STE 4060",
            "city": "KENNESAW",
            "state": "GA",
            "postal_code": "301444949",
            "telephone_number": "678-905-6300",
            "fax_number": "678-905-6301"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNER",
        "first_name": "LECHANDRE",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2019-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000946536L",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000946536AP",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000946536C",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Info@floss365dental.com",
            "affiliation": "N",
            "endpointDescription": "email of office",
            "address_1": "425 Barrett Pkwy Ste 4060",
            "city": "Kennesaw",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301444949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LECHANDRE",
            "last_name": "WADLEY",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Leigh Anne Bohacek, MPT
• Abby Caudle Bohler, AU.D.
• Sarah B. Bolick, PA
• Jennifer Boner
• Laura Bonin, DPT
• Amber Booth, RBT
• Born Again Chiropractic
• Maria Isabella Bourjolly
• Mauresha Marchell Bowden, LMSW
• Alexis Bower, M.A., BCBA

• All providers in Kennesaw, GA
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.