Provider Demographics
NPI:1275964777
Name:BONITA C. HORNSTEIN, D.D.S.
Entity Type:Organization
Organization Name:BONITA C. HORNSTEIN, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:C
Authorized Official - Last Name:HORNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-477-1777
Mailing Address - Street 1:1950 SAWTELLE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-7014
Mailing Address - Country:US
Mailing Address - Phone:310-477-1777
Mailing Address - Fax:310-312-0290
Practice Address - Street 1:1950 SAWTELLE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-7014
Practice Address - Country:US
Practice Address - Phone:310-477-1777
Practice Address - Fax:310-312-0290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0316301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty