Provider Demographics
NPI:1467620690
Name:BONN, KEVIN T (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:T
Last Name:BONN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 RINEHART RD
Mailing Address - Street 2:STE 110
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4801
Mailing Address - Country:US
Mailing Address - Phone:407-333-7393
Mailing Address - Fax:407-333-3991
Practice Address - Street 1:570 RINEHART RD
Practice Address - Street 2:STE 110
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-4801
Practice Address - Country:US
Practice Address - Phone:407-333-7393
Practice Address - Fax:407-333-3991
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL99871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice