Provider Demographics
NPI:1235715137
Name:BONNELL, LAURA JEAN KNOPP (RDH)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JEAN KNOPP
Last Name:BONNELL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4545 TREEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-4300
Mailing Address - Country:US
Mailing Address - Phone:513-544-8709
Mailing Address - Fax:
Practice Address - Street 1:1525 ELM ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-6957
Practice Address - Country:US
Practice Address - Phone:513-544-8709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31.013060124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist