Provider Demographics
NPI:1750556908
Name:THOMAS C. BONUSO D.D.S., CHARLES T. CAMACHO D.D.S.
Entity type:Organization
Organization Name:THOMAS C. BONUSO D.D.S., CHARLES T. CAMACHO D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:BONUSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-882-8387
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL019014273Medicaid