Provider Demographics
NPI:1184837726
Name:BONIN, KODY JUDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KODY
Middle Name:JUDE
Last Name:BONIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7302 AUGUSTA PINES DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-2127
Mailing Address - Country:US
Mailing Address - Phone:281-376-7200
Mailing Address - Fax:
Practice Address - Street 1:16835 DEER CREEK DR STE 230
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4895
Practice Address - Country:US
Practice Address - Phone:281-376-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist