Provider Demographics
NPI:1033521836
Name:BERTRAND A. BONNICK,D.D.S.,P.L.L.C.
Entity Type:Organization
Organization Name:BERTRAND A. BONNICK,D.D.S.,P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BERTRAND
Authorized Official - Middle Name:A
Authorized Official - Last Name:BONNICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-841-0000
Mailing Address - Street 1:2783 NC HIGHWAY 68 S
Mailing Address - Street 2:SUITE #107
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8324
Mailing Address - Country:US
Mailing Address - Phone:336-841-0000
Mailing Address - Fax:336-841-0001
Practice Address - Street 1:2783 NC HIGHWAY 68 S
Practice Address - Street 2:SUITE #107
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8324
Practice Address - Country:US
Practice Address - Phone:336-841-0000
Practice Address - Fax:336-841-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC076721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty