Provider Demographics
NPI:1932323805
Name:BONCORE, ANGELO GUY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELO
Middle Name:GUY
Last Name:BONCORE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3319
Mailing Address - Country:US
Mailing Address - Phone:781-631-7950
Mailing Address - Fax:781-631-7953
Practice Address - Street 1:37 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:MARBLEHEAD
Practice Address - State:MA
Practice Address - Zip Code:01945-3319
Practice Address - Country:US
Practice Address - Phone:781-631-7950
Practice Address - Fax:781-631-7953
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice