Provider Demographics
NPI:1154549582
Name:BONURA, ANTHONY BRUCE (DMD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:BRUCE
Last Name:BONURA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:HASBROUCK HEIGHTS
Mailing Address - State:NJ
Mailing Address - Zip Code:07604-1909
Mailing Address - Country:US
Mailing Address - Phone:201-288-2727
Mailing Address - Fax:201-288-2562
Practice Address - Street 1:217 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:HASBROUCK HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07604-1909
Practice Address - Country:US
Practice Address - Phone:201-288-2727
Practice Address - Fax:201-288-2562
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1012766001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice