Provider Demographics
NPI:1265429286
Name:WYNKOOP, BONITA ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:BONITA
Middle Name:ANN
Last Name:WYNKOOP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2200 SPACE PARK DR
Mailing Address - Street 2:#300
Mailing Address - City:NASSAU BAY
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3677
Mailing Address - Country:US
Mailing Address - Phone:281-333-3406
Mailing Address - Fax:281-333-3442
Practice Address - Street 1:2200 SPACE PARK DR
Practice Address - Street 2:#300
Practice Address - City:NASSAU BAY
Practice Address - State:TX
Practice Address - Zip Code:77058-3677
Practice Address - Country:US
Practice Address - Phone:281-333-3406
Practice Address - Fax:281-333-3442
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX169471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice