Provider Demographics
NPI:1336165372
Name:BONGHI, JOHN J (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:BONGHI
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 1:151 BUFFALO AVENUE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14303-1290
Mailing Address - Country:US
Mailing Address - Phone:716-285-6268
Mailing Address - Fax:716-285-0066
Practice Address - Street 1:151 BUFFALO AVENUE
Practice Address - Street 2:SUITE 208
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14303-1290
Practice Address - Country:US
Practice Address - Phone:716-285-6268
Practice Address - Fax:716-285-0066
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027417122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00605692Medicaid