MEDICARE: DR. KRISTEN NICOLE DE BONIS D.M.D.

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
1	1223G0001X	General Practice Dentistry	DN 19725	FL

General Provider Information

NPI Number	:	1881959070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTEN NICOLE DE BONIS D.M.D.

Provider Business Mailing Address
First Line	:	7000 SAWGRASS VILLAGE CIR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5014
Country	:	US
Telephone Number	:	904-280-1200
Fax Number	:	904-280-0001

Provider Business Practice Location Address
First Line	:	7000 SAWGRASS VILLAGE CIR
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-5014
Country	:	US
Telephone Number	:	904-280-1200
Fax Number	:	904-280-0001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2012
Last Update Date	:	03/27/2025

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