Provider Demographics
NPI:1720009202
Name:BONNEVIE, DANIEL RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAYMOND
Last Name:BONNEVIE
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 1:6 ROSE TER
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19444-1635
Mailing Address - Country:US
Mailing Address - Phone:215-233-5179
Mailing Address - Fax:215-233-0909
Practice Address - Street 1:6 ROSE TER
Practice Address - Street 2:
Practice Address - City:LAFAYETTE HILL
Practice Address - State:PA
Practice Address - Zip Code:19444-1635
Practice Address - Country:US
Practice Address - Phone:215-233-0909
Practice Address - Fax:215-233-0909
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS023411L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice