Provider Demographics
NPI:1447748835
Name:JESSICA M. BONIFATE DDS, P.C.
Entity Type:Organization
Organization Name:JESSICA M. BONIFATE DDS, P.C.
Other - Org Name:BRONXVILLE FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BONIFATE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:914-337-8430
Mailing Address - Street 1:1 PONDFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3706
Mailing Address - Country:US
Mailing Address - Phone:914-337-8430
Mailing Address - Fax:
Practice Address - Street 1:1 PONDFIELD RD
Practice Address - Street 2:
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3706
Practice Address - Country:US
Practice Address - Phone:914-337-8430
Practice Address - Fax:914-337-8433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental