Provider Demographics
NPI:1376710772
Name:BONHAM, PAUL EUGENE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EUGENE
Last Name:BONHAM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 HOOHANA ST
Mailing Address - Street 2:SUITE 312
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2400
Mailing Address - Country:US
Mailing Address - Phone:808-871-6576
Mailing Address - Fax:
Practice Address - Street 1:140 HOOHANA ST
Practice Address - Street 2:SUITE 312
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2400
Practice Address - Country:US
Practice Address - Phone:808-871-6576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT23041223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics