Provider Demographics
NPI:1295738177
Name:BONUSO, THOMAS C (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:BONUSO
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 1:1061 N SALEM DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60194-1331
Mailing Address - Country:US
Mailing Address - Phone:847-882-8387
Mailing Address - Fax:847-882-8450
Practice Address - Street 1:1061 N SALEM DR
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60194-1331
Practice Address - Country:US
Practice Address - Phone:847-882-8387
Practice Address - Fax:847-882-8450
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice