Healthcare Provider Details

I. General information

NPI: 1619819745
Provider Name (Legal Business Name): JAVIER BONAMEGO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: JAVIER ALBERTO SOWERS

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1980 US HIGHWAY 1 S
SAINT AUGUSTINE FL
32086-4233
US

IV. Provider business mailing address

1980 US HIGHWAY 1 S
SAINT AUGUSTINE FL
32086-4233
US

V. Phone/Fax

Practice location:
  • Phone: 904-385-1936
  • Fax:
Mailing address:
  • Phone: 904-659-8047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: