Provider Demographics
NPI:1689236408
Name:BONZELL, STEVEN MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MATTHEW
Last Name:BONZELL
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 1:621 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3605
Mailing Address - Country:US
Mailing Address - Phone:916-792-3946
Mailing Address - Fax:
Practice Address - Street 1:565 BRUNSWICK RD STE 14
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-9529
Practice Address - Country:US
Practice Address - Phone:530-272-6752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103887122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist