Provider Demographics
NPI:1760674642
Name:BONICK, JAMES F (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:F
Last Name:BONICK
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 1:8585 BROADWAY
Mailing Address - Street 2:SUITE 725
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-7064
Mailing Address - Country:US
Mailing Address - Phone:219-769-2200
Mailing Address - Fax:219-769-0165
Practice Address - Street 1:8585 BROADWAY
Practice Address - Street 2:SUITE 725
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-7064
Practice Address - Country:US
Practice Address - Phone:219-769-2200
Practice Address - Fax:219-769-0165
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120088771223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics