Provider Demographics
NPI:1720015100
Name:BONFANTE, DAVID GEORGE (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE
Last Name:BONFANTE
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 1:3673 ESSEX RD
Mailing Address - Street 2:PO BOX 310
Mailing Address - City:WILLSBORO
Mailing Address - State:NY
Mailing Address - Zip Code:12996
Mailing Address - Country:US
Mailing Address - Phone:518-963-7307
Mailing Address - Fax:
Practice Address - Street 1:3673 ESSEX RD
Practice Address - Street 2:SUITE 2
Practice Address - City:WILLSBORO
Practice Address - State:NY
Practice Address - Zip Code:12996
Practice Address - Country:US
Practice Address - Phone:518-963-7307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030808122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist