Provider Demographics
NPI:1548216385
Name:BONURA, JOHN HOEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:HOEY
Last Name:BONURA
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 1:20714 168TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:FL
Mailing Address - Zip Code:32060-5285
Mailing Address - Country:US
Mailing Address - Phone:386-776-2532
Mailing Address - Fax:386-776-3132
Practice Address - Street 1:20714 168TH ST
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:FL
Practice Address - Zip Code:32060-5285
Practice Address - Country:US
Practice Address - Phone:386-776-2532
Practice Address - Fax:386-776-3132
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 122701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice