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General NPI Number Information
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NPI Number | 1891067393
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Entity Type | Individual
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Provider Name | FERNANDO BONILLAS TENORIO DDS
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Gender | Male
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Dates
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Enumeration Date | 01/31/2012
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Last Update Date | 01/31/2012
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Provider Practice Location Address
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Address Line | ARIAS BERNAL 665 ZONA CENTRO
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City | TIJUANA
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State | BC
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Zip | 22000
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Country | MX
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Telephone | 526646374287
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 MADDIE LN
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City | SAN DIEGO
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State | CA
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Zip | 92154-2184
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Country | US
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Telephone | 619-623-3471
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 896811
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License Number State | ZZ
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 4512687
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License Number State | ZZ
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