MEDICARE: DR. JAMES KEVIN BONGERS D,D,S,

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	5656	KS

General Provider Information

NPI Number	:	1598736381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES KEVIN BONGERS D,D,S,

Provider Business Mailing Address
First Line	:	5108 FOUNDERS WAY
Second Line	:
City	:	MANHATTAN
State	:	KS
Zip	:	66503-8692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1038 W ASH ST
Second Line	:
City	:	JUNCTION CITY
State	:	KS
Zip	:	66441-3462
Country	:	US
Telephone Number	:	785-762-4313
Fax Number	:	785-762-6500

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	07/08/2007

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