Provider Demographics
NPI:1073773495
Name:BONNEVIE, DAVID R (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:BONNEVIE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 LANCELOT DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3093
Mailing Address - Country:US
Mailing Address - Phone:716-297-1644
Mailing Address - Fax:716-297-9855
Practice Address - Street 1:2145 LANCELOT DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3093
Practice Address - Country:US
Practice Address - Phone:716-297-1644
Practice Address - Fax:716-297-9855
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035042122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00644380Medicaid