Provider Demographics
NPI:1386667285
Name:BONILLA, ESTHER LAURA (DDS)
Entity Type:Individual
Prefix:
First Name:ESTHER LAURA
Middle Name:
Last Name: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 1:343 W HOUSTON ST
Mailing Address - Street 2:SUITE112
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2107
Mailing Address - Country:US
Mailing Address - Phone:210-228-0084
Mailing Address - Fax:210-224-1142
Practice Address - Street 1:343 W HOUSTON ST
Practice Address - Street 2:SUITE112
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2107
Practice Address - Country:US
Practice Address - Phone:210-228-0084
Practice Address - Fax:210-224-1142
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice