Provider Demographics
NPI:1700052727
Name:BONIN, GENEVIEVE (DMD)
Entity Type:Individual
Prefix:DR
First Name:GENEVIEVE
Middle Name:
Last Name:BONIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 QUINCY ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1802
Mailing Address - Country:US
Mailing Address - Phone:617-447-4471
Mailing Address - Fax:
Practice Address - Street 1:58 QUINCY ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-1802
Practice Address - Country:US
Practice Address - Phone:617-447-4471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA95281223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery