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General NPI Number Information
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NPI Number | 1710586433
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Entity Type | Organization
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Legal Business Name | BONITA DENTAL GROUP PLLC
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Dates
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Enumeration Date | 10/23/2020
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Last Update Date | 10/23/2020
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Provider Practice Location Address
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Address Line | 328 NEWBURY ST
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City | BOSTON
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State | MA
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Zip | 02115-2715
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Country | US
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Telephone | 617-536-5182
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Fax |
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Provider Business Mailing Address
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Address Line | 328 NEWBURY ST
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City | BOSTON
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State | MA
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Zip | 02115-2715
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | WILLIAM HERR
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Credential | DDS
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Telephone | 419-438-4789
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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 |
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License Number State |
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