Provider Demographics
NPI:1225006554
Name:DEAN, BONNIE MUZENIC (MD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:MUZENIC
Last Name:DEAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 TARNHILL DR
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:NC
Mailing Address - Zip Code:28731-9704
Mailing Address - Country:US
Mailing Address - Phone:828-507-3717
Mailing Address - Fax:
Practice Address - Street 1:2686 GREENVILLE HWY STE B
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731-9607
Practice Address - Country:US
Practice Address - Phone:828-507-3717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-11
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32475207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL48957VMedicare PIN
FLD21659Medicare UPIN