Provider Demographics
NPI:1144595901
Name:RAYMOND BONOMO PERIODONTICS
Entity Type:Organization
Organization Name:RAYMOND BONOMO PERIODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:BONOMO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:513-671-0222
Mailing Address - Street 1:34 REMICK BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-9168
Mailing Address - Country:US
Mailing Address - Phone:937-886-9940
Mailing Address - Fax:937-886-9945
Practice Address - Street 1:424 RAY NORRISH DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1520
Practice Address - Country:US
Practice Address - Phone:513-671-0222
Practice Address - Fax:513-671-0256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0214491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1588715726OtherNPI #