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General NPI Number Information
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NPI Number | 1033409115
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Entity Type | Individual
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Provider Name | JESSICA M BONIFATE D.D.S
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Gender | Female
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 11/14/2023
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Provider Practice Location Address
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Address Line | 1 PONDFIELD RD STE 103
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City | BRONXVILLE
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State | NY
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Zip | 10708-3706
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Country | US
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Telephone | 914-337-8430
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Fax | 914-337-8433
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Provider Business Mailing Address
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Address Line | 1 PONDFIELD RD STE 103
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City | BRONXVILLE
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State | NY
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Zip | 10708-3706
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Country | US
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Telephone | 914-337-8430
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Fax | 914-337-8433
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 053038
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License Number State | NY
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