Healthcare Provider Details

I. General information

NPI: 1447274030
Provider Name (Legal Business Name): STUART BONNIN DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 E OLIVE RD
PENSACOLA FL
32514-6241
US

IV. Provider business mailing address

3201 E OLIVE RD
PENSACOLA FL
32514-6241
US

V. Phone/Fax

Practice location:
  • Phone: 850-477-1722
  • Fax: 850-476-8108
Mailing address:
  • Phone: 850-477-1722
  • Fax: 850-476-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberFLDD15110
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License NumberDN15110
License Number StateFL

VIII. Authorized Official

Name: DR. STUART FRANCIS BONNIN
Title or Position: PEDIATRIC DENTIST
Credential: DMD
Phone: 850-477-1722