Provider Demographics
NPI:1144352527
Name:BONACCI, SARA BETH (DDS)
Entity type:Individual
Prefix:DR
First Name:SARA BETH
Middle Name:
Last Name:BONACCI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:SARA BETH
Other - Middle Name:
Other - Last Name:WOODHEAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 11170
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13218-1170
Mailing Address - Country:US
Mailing Address - Phone:315-422-1305
Mailing Address - Fax:315-422-3133
Practice Address - Street 1:801 N SALINA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13208-2512
Practice Address - Country:US
Practice Address - Phone:315-422-1305
Practice Address - Fax:315-422-3133
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0522941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice