Provider Demographics
NPI:1619006939
Name:BONFIGLIO, DANIEL ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ARTHUR
Last Name:BONFIGLIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 S SHORE DR
Mailing Address - Street 2:SUITE 309
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-4466
Mailing Address - Country:US
Mailing Address - Phone:269-964-4895
Mailing Address - Fax:
Practice Address - Street 1:395 S SHORE DR
Practice Address - Street 2:SUITE 309
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-4466
Practice Address - Country:US
Practice Address - Phone:269-964-4895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0127731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice