MEDICARE: DR. BONNIE RAE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	17478	FL

General Provider Information

NPI Number	:	1528239076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONNIE RAE DMD

Provider Business Mailing Address
First Line	:	4665 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3800
Country	:	US
Telephone Number	:	561-498-0050
Fax Number	:

Provider Business Practice Location Address
First Line	:	4665 W ATLANTIC AVE
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33445-3800
Country	:	US
Telephone Number	:	561-498-0050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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