Provider Demographics
NPI:1093864530
Name:BONO, SUZANNE M (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:M
Last Name:BONO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8747 N OKETO AVE
Mailing Address - Street 2:
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-2068
Mailing Address - Country:US
Mailing Address - Phone:847-966-4566
Mailing Address - Fax:
Practice Address - Street 1:8747 N OKETO AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2068
Practice Address - Country:US
Practice Address - Phone:847-966-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice