Healthcare Provider Details

I. General information

NPI: 1700989209
Provider Name (Legal Business Name): JAMES BRYAN BONNY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 W STATE HWY 198 SUITE 6
SALEM UT
84653
US

IV. Provider business mailing address

245 WEST STATE HWY 198 SUITE 6 PO BOX 920
SALEM UT
84651
US

V. Phone/Fax

Practice location:
  • Phone: 801-423-2244
  • Fax: 801-423-9171
Mailing address:
  • Phone: 801-423-2244
  • Fax: 801-423-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: