Provider Demographics
NPI:1437693223
Name:TURNER, BONITA (RDH)
Entity Type:Individual
Prefix:
First Name:BONITA
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 S LAKEWOOD DR
Mailing Address - Street 2:MOBILE DENTAL
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2815
Mailing Address - Country:US
Mailing Address - Phone:813-653-6126
Mailing Address - Fax:813-685-2110
Practice Address - Street 1:313 S LAKEWOOD DR
Practice Address - Street 2:MOBILE DENTAL
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-2815
Practice Address - Country:US
Practice Address - Phone:813-653-6126
Practice Address - Fax:813-685-2110
Is Sole Proprietor?:No
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7458124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist