Provider Demographics
NPI:1144209156
Name:BUONO, DENNIS J (DO)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:J
Last Name:BUONO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 E HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2607
Mailing Address - Country:US
Mailing Address - Phone:419-732-9975
Mailing Address - Fax:419-732-6415
Practice Address - Street 1:2621 E HARBOR RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2607
Practice Address - Country:US
Practice Address - Phone:419-732-9975
Practice Address - Fax:419-732-6415
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008701207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2634466Medicaid
MIBB8303543OtherDEA
OH2634466Medicaid