Provider Demographics
NPI:1679631915
Name:BONNER, SALLYANNE KATHRYN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SALLYANNE
Middle Name:KATHRYN
Last Name:BONNER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SALLYANNE
Other - Middle Name:BONNER
Other - Last Name:KROWICKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:126 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NJ
Mailing Address - Zip Code:08833-2126
Mailing Address - Country:US
Mailing Address - Phone:908-236-9650
Mailing Address - Fax:908-236-7943
Practice Address - Street 1:126 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NJ
Practice Address - Zip Code:08833-2126
Practice Address - Country:US
Practice Address - Phone:908-236-9650
Practice Address - Fax:908-236-7943
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ108241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice