Healthcare Provider Details

I. General information

NPI: 1245491471
Provider Name (Legal Business Name): BONNESS FAMILY DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 06/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10701 ALLIANCE DR SUITE F
CAMBY IN
46113-8836
US

IV. Provider business mailing address

10701 ALLIANCE DR SUITE F
CAMBY IN
46113-8836
US

V. Phone/Fax

Practice location:
  • Phone: 317-821-1130
  • Fax: 317-821-1145
Mailing address:
  • Phone: 317-821-1130
  • Fax: 317-821-1145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12010300A
License Number StateIN

VIII. Authorized Official

Name: RICHARD AARON BONNESS
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 317-821-1130