Provider Demographics
NPI:1508855610
Name:BONNESS, BRYCE W (DDS)
Entity Type:Individual
Prefix:MR
First Name:BRYCE
Middle Name:W
Last Name:BONNESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3901 NORMAL BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5261
Mailing Address - Country:US
Mailing Address - Phone:402-486-3630
Mailing Address - Fax:402-486-3637
Practice Address - Street 1:3901 NORMAL BLVD
Practice Address - Street 2:STE 205
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5261
Practice Address - Country:US
Practice Address - Phone:402-486-3630
Practice Address - Fax:402-486-3637
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE36601223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics