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General NPI Number Information
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NPI Number | 1215227004
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Entity Type | Individual
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Provider Name | ALYSSA BONTA M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 08/13/2024
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Provider Practice Location Address
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Address Line | 3533 SOUTHERN BLVD STE 2200
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City | DAYTON
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State | OH
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Zip | 45429-1264
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Country | US
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Telephone | 937-228-4126
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Fax | 937-424-8659
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Provider Business Mailing Address
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Address Line | 1 PRESTIGE PL STE 550
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City | MIAMISBURG
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State | OH
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Zip | 45342-6115
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Country | US
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Telephone | 937-762-1310
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Fax | 937-522-8493
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 35.122523
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 35.122523
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License Number State | OH
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