Provider Demographics
NPI:1518189679
Name:BONNELL, ROBIN ELAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ELAINE
Last Name:BONNELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 PINELLA DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-8763
Mailing Address - Country:US
Mailing Address - Phone:606-261-7309
Mailing Address - Fax:
Practice Address - Street 1:16 WINDBURN DR
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7843
Practice Address - Country:US
Practice Address - Phone:606-261-7309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8692122300000X
VA04014101531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice