Provider Demographics
NPI:1811998339
Name:BONOM, MILES HUGH (DDS)
Entity type:Individual
Prefix:DR
First Name:MILES
Middle Name:HUGH
Last Name:BONOM
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 1:838 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1913
Mailing Address - Country:US
Mailing Address - Phone:203-322-5153
Mailing Address - Fax:203-329-9151
Practice Address - Street 1:838 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1913
Practice Address - Country:US
Practice Address - Phone:203-322-5153
Practice Address - Fax:203-329-9151
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist