Provider Demographics
NPI:1346806791
Name:SCOTT C. BONIN D.D.S. A PROFESSIONAL DENAL CORPORATION
Entity Type:Organization
Organization Name:SCOTT C. BONIN D.D.S. A PROFESSIONAL DENAL CORPORATION
Other - Org Name:BONIN FAMILY DENTIST AND DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:COLLIER
Authorized Official - Last Name:BONIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-733-7947
Mailing Address - Street 1:100 WINDSOR RIVER RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-9204
Mailing Address - Country:US
Mailing Address - Phone:707-838-1400
Mailing Address - Fax:707-838-1489
Practice Address - Street 1:100 WINDSOR RIVER RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-9204
Practice Address - Country:US
Practice Address - Phone:707-838-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-11
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty