MEDICARE: DR. MARK TODD BONIN 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	15387	TX

General Provider Information

NPI Number	:	1710191614
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK TODD BONIN D.D.S.

Provider Business Mailing Address
First Line	:	17222 RED OAK DR
Second Line	:	SUITE 107
City	:	HOUSTON
State	:	TX
Zip	:	77090-2648
Country	:	US
Telephone Number	:	281-440-3530
Fax Number	:	281-440-5580

Provider Business Practice Location Address
First Line	:	17222 RED OAK DR
Second Line	:	SUITE 107
City	:	HOUSTON
State	:	TX
Zip	:	77090-2648
Country	:	US
Telephone Number	:	281-440-3530
Fax Number	:	281-440-5580

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	03/11/2008

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