Provider Demographics
NPI:1346338712
Name:ULERIO-BONILLA, ISABEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ISABEL
Middle Name:
Last Name:ULERIO-BONILLA
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 1:577 ISHAM ST
Mailing Address - Street 2:SUITE 1-G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-2034
Mailing Address - Country:US
Mailing Address - Phone:212-942-9900
Mailing Address - Fax:212-942-2388
Practice Address - Street 1:577 ISHAM ST
Practice Address - Street 2:SUITE 1-G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-2034
Practice Address - Country:US
Practice Address - Phone:212-942-9900
Practice Address - Fax:212-942-2388
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045323122300000X
NJ22D102072400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01510269Medicaid