Provider Demographics
NPI:1528407277
Name:WHITEHURST, CHRISTINA BONNO (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:BONNO
Last Name:WHITEHURST
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 649
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-0649
Mailing Address - Country:US
Mailing Address - Phone:409-925-2555
Mailing Address - Fax:
Practice Address - Street 1:12810 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77510-8613
Practice Address - Country:US
Practice Address - Phone:409-925-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29062122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist