Provider Demographics
NPI:1881959070
Name:DE BONIS, KRISTEN NICOLE (DMD)
Entity type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NICOLE
Last Name:DE BONIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:HORNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7000 SAWGRASS VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5014
Mailing Address - Country:US
Mailing Address - Phone:904-280-1200
Mailing Address - Fax:904-280-0001
Practice Address - Street 1:7000 SAWGRASS VILLAGE CIR
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-5014
Practice Address - Country:US
Practice Address - Phone:904-280-1200
Practice Address - Fax:904-280-0001
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 197251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice