Healthcare Provider Details

I. General information

NPI: 1982479242
Provider Name (Legal Business Name): JOHN B DEBONIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2023
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 LINCOLN AVE
BELLEVUE PA
15202-3629
US

IV. Provider business mailing address

463 LINCOLN AVE
BELLEVUE PA
15202-3629
US

V. Phone/Fax

Practice location:
  • Phone: 412-761-9594
  • Fax: 412-766-0495
Mailing address:
  • Phone: 412-761-9594
  • Fax: 412-766-0495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: JOHN B DEBONIS
Title or Position: OWNER
Credential: DMD
Phone: 412-761-9594