MEDICARE: DR. JOHN HOEY BONURA 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	DN 12270	FL

General Provider Information

NPI Number	:	1548216385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN HOEY BONURA DMD

Provider Business Mailing Address
First Line	:	20714 168TH ST
Second Line	:
City	:	LIVE OAK
State	:	FL
Zip	:	32060-5285
Country	:	US
Telephone Number	:	386-776-2532
Fax Number	:	386-776-3132

Provider Business Practice Location Address
First Line	:	20714 168TH ST
Second Line	:
City	:	LIVE OAK
State	:	FL
Zip	:	32060-5285
Country	:	US
Telephone Number	:	386-776-2532
Fax Number	:	386-776-3132

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

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	07/08/2007

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