Provider Demographics
NPI:1093859217
Name:BONAVENTURA, GINA MARIE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:BONAVENTURA
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 SUNRISE BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8514
Mailing Address - Country:US
Mailing Address - Phone:281-854-2960
Mailing Address - Fax:281-854-2961
Practice Address - Street 1:2734 SUNRISE BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-8514
Practice Address - Country:US
Practice Address - Phone:281-854-2960
Practice Address - Fax:281-854-2961
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX196591223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics