Provider Demographics
NPI:1073968731
Name:BONO, THOMAS DALE
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DALE
Last Name:BONO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 TENNYSON AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-2536
Mailing Address - Country:US
Mailing Address - Phone:719-660-4757
Mailing Address - Fax:
Practice Address - Street 1:4104 TENNYSON AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-2536
Practice Address - Country:US
Practice Address - Phone:719-660-4757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care