Provider Demographics
NPI:1225365505
Name:YELLIN, BONNIE LEAH (DDS)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LEAH
Last Name:YELLIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-2829
Mailing Address - Country:US
Mailing Address - Phone:631-265-3377
Mailing Address - Fax:631-265-0120
Practice Address - Street 1:525 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2829
Practice Address - Country:US
Practice Address - Phone:631-265-3377
Practice Address - Fax:631-265-0120
Is Sole Proprietor?:No
Enumeration Date:2009-11-08
Last Update Date:2009-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039984-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics