Provider Demographics
NPI:1629797758
Name:GREGG S. BONAMICI DDS, PC
Entity Type:Organization
Organization Name:GREGG S. BONAMICI DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:BONAMICI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-565-8544
Mailing Address - Street 1:9780 HAWTHORNE GLEN DR
Mailing Address - Street 2:
Mailing Address - City:GROSSE ILE
Mailing Address - State:MI
Mailing Address - Zip Code:48138-1686
Mailing Address - Country:US
Mailing Address - Phone:734-552-9277
Mailing Address - Fax:
Practice Address - Street 1:23601 FORD RD STE 2
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48128-1259
Practice Address - Country:US
Practice Address - Phone:313-565-8544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty