Provider Demographics
NPI:1164851796
Name:BONNER, GAREY A SR (DMD,PA)
Entity Type:Individual
Prefix:DR
First Name:GAREY
Middle Name:A
Last Name:BONNER
Suffix:SR
Gender:M
Credentials:DMD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 MISSISSIPPI DR
Mailing Address - Street 2:PO BOX 482
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2438
Mailing Address - Country:US
Mailing Address - Phone:601-735-5086
Mailing Address - Fax:601-735-5089
Practice Address - Street 1:806 MISSISSIPPI DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2438
Practice Address - Country:US
Practice Address - Phone:601-735-5086
Practice Address - Fax:601-735-5089
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1919-811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1114096856OtherNPI