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NPI Code Detail

MEDICARE: CAYTLYN FOY BONURA DDS

MEDICARE:   CAYTLYN FOY BONURA  DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
21223G0001XGeneral Practice Dentistry28727TX
31223G0001XGeneral Practice DentistryDD3693NM

General Provider Information

NPI Number : 1275808800
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAYTLYN FOY BONURA DDS
Provider Business Mailing Address
First Line : 1608 N BENNETT ST
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-5654
Country : US
Telephone Number : 575-534-3699
Fax Number : 575-534-3698
Provider Business Practice Location Address
First Line : 1608 N BENNETT ST
Second Line :
City : SILVER CITY
State : NM
Zip : 88061-5654
Country : US
Telephone Number : 575-534-3699
Fax Number : 575-534-3698
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2012
Last Update Date : 08/04/2016

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Directions to “ CAYTLYN FOY BONURA DDS” Practice Location

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