Provider Demographics
NPI:1982479242
Name:JOHN B DEBONIS
Entity Type:Organization
Organization Name:JOHN B DEBONIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:DEBONIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:412-761-9594
Mailing Address - Street 1:463 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3629
Mailing Address - Country:US
Mailing Address - Phone:412-761-9594
Mailing Address - Fax:412-766-0495
Practice Address - Street 1:463 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202-3629
Practice Address - Country:US
Practice Address - Phone:412-761-9594
Practice Address - Fax:412-766-0495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty