Provider Demographics
NPI:1518395060
Name:SLATKIN, BONNIE (RDHAP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:SLATKIN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 STRANAHAN CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:CA
Mailing Address - Zip Code:94517-1456
Mailing Address - Country:US
Mailing Address - Phone:925-788-2035
Mailing Address - Fax:
Practice Address - Street 1:278 STRANAHAN CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1456
Practice Address - Country:US
Practice Address - Phone:925-788-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA490124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist