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General NPI Number Information
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NPI Number | 1245491471
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Entity Type | Organization
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Legal Business Name | BONNESS FAMILY DENTISTRY PC
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Dates
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Enumeration Date | 06/20/2008
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 10701 ALLIANCE DR SUITE F
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City | CAMBY
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State | IN
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Zip | 46113-8836
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Country | US
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Telephone | 317-821-1130
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Fax | 317-821-1145
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Provider Business Mailing Address
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Address Line | 10701 ALLIANCE DR SUITE F
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City | CAMBY
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State | IN
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Zip | 46113-8836
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Country | US
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Telephone | 317-821-1130
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Fax | 317-821-1145
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD AARON BONNESS
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Credential | D.D.S.
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Telephone | 317-821-1130
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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 | 12010300A
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License Number State | IN
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