Provider Demographics
NPI:1780766006
Name:BONNESS, ANN MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:MICHELLE
Last Name:BONNESS
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 1:10701 ALLIANCE DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-8836
Mailing Address - Country:US
Mailing Address - Phone:317-821-1130
Mailing Address - Fax:317-821-1145
Practice Address - Street 1:10701 ALLIANCE DR
Practice Address - Street 2:SUITE F
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8836
Practice Address - Country:US
Practice Address - Phone:317-821-1130
Practice Address - Fax:317-821-1145
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010488A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice