Healthcare Provider Details

I. General information

NPI: 1902732787
Provider Name (Legal Business Name): CARTER WESLEY AN BONAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 WOODMAN DR
DAYTON OH
45432-3439
US

IV. Provider business mailing address

309 N MAIN ST
CHRISTIANSBURG OH
45389-5001
US

V. Phone/Fax

Practice location:
  • Phone: 513-740-1001
  • Fax:
Mailing address:
  • Phone: 937-896-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: