Provider Demographics
NPI:1407602329
Name:STEVEN BONZELL DDS INC
Entity type:Organization
Organization Name:STEVEN BONZELL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEM
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BONZELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-792-3946
Mailing Address - Street 1:3832 SOUTHPARK PL
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24400 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631-9334
Practice Address - Country:US
Practice Address - Phone:530-367-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental