Provider Demographics
NPI:1306885868
Name:BONFESSUTO, DAVID C (RPH, DC, RN, NP-C)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:BONFESSUTO
Suffix:
Gender:M
Credentials:RPH, DC, RN, NP-C
Other - Prefix:
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Mailing Address - Street 1:PO BOX 5608
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0219
Mailing Address - Country:US
Mailing Address - Phone:214-335-5870
Mailing Address - Fax:972-559-1759
Practice Address - Street 1:6420 N MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2848
Practice Address - Country:US
Practice Address - Phone:214-335-5870
Practice Address - Fax:972-559-1759
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX9057111N00000X
TX405771835N1003X
TX774297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support