Provider Demographics
NPI:1881858017
Name:BONIN, TROY C (DDS)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:C
Last Name:BONIN
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 1:5403 FM 1488 RD STE A-7
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-2524
Mailing Address - Country:US
Mailing Address - Phone:281-259-6717
Mailing Address - Fax:
Practice Address - Street 1:5403 FM 1488 RD
Practice Address - Street 2:STE A-7 (REPUBLIC OF TEXAS)
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-2524
Practice Address - Country:US
Practice Address - Phone:281-259-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX17133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist