Provider Demographics
NPI:1346651817
Name:UST, BONNIE MURO (DDS)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:MURO
Last Name:UST
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 1:1029 NURSERY AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-2321
Mailing Address - Country:US
Mailing Address - Phone:504-460-3419
Mailing Address - Fax:
Practice Address - Street 1:3939 HOUMA BLVD
Practice Address - Street 2:BUILDING 3 SUITE 11
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2931
Practice Address - Country:US
Practice Address - Phone:504-460-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA64551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice