Provider Demographics
NPI:1275808800
Name:BONURA, CAYTLYN FOY (DDS)
Entity Type:Individual
Prefix:
First Name:CAYTLYN
Middle Name:FOY
Last Name:BONURA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CAYTLYN
Other - Middle Name:
Other - Last Name:FOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1608 N BENNETT ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-5654
Mailing Address - Country:US
Mailing Address - Phone:575-534-3699
Mailing Address - Fax:575-534-3698
Practice Address - Street 1:1608 N BENNETT ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-5654
Practice Address - Country:US
Practice Address - Phone:575-534-3699
Practice Address - Fax:575-534-3698
Is Sole Proprietor?:No
Enumeration Date:2012-03-15
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX287271223G0001X
NMDD36931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program