Provider Demographics
NPI:1932830767
Name:BONNETTE, CARLY ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARLY
Middle Name:ELIZABETH
Last Name:BONNETTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 DIANE LN
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078-9653
Mailing Address - Country:US
Mailing Address - Phone:318-542-6371
Mailing Address - Fax:
Practice Address - Street 1:910 BERT KOUNS INDUSTRIAL LOOP
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3410
Practice Address - Country:US
Practice Address - Phone:318-686-7470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist