Provider Demographics
NPI:1417148875
Name:BONAVOGLIA, ANTHONY VITO (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VITO
Last Name:BONAVOGLIA
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7 MORAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-2803
Mailing Address - Country:US
Mailing Address - Phone:845-297-7045
Mailing Address - Fax:845-297-7046
Practice Address - Street 1:7 MORAN AVE
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-2803
Practice Address - Country:US
Practice Address - Phone:845-297-7045
Practice Address - Fax:845-297-7046
Is Sole Proprietor?:No
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053376-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics