Healthcare Provider Details

I. General information

NPI: 1902173628
Provider Name (Legal Business Name): BONNIE JEAN HUNT DHAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BONNIE JEAN JOHNSON DHAT

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 KWIGUK ST.
EMMONAK AK
99581-0246
US

IV. Provider business mailing address

246 KWIGUK STREET
EMMONAK AK
99581-0246
US

V. Phone/Fax

Practice location:
  • Phone: 907-949-3536
  • Fax: 904-949-3540
Mailing address:
  • Phone: 907-949-3536
  • Fax: 907-949-3540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code125J00000X
TaxonomyDental Therapist
License Number26-00772-DHAT
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: