Provider Demographics
NPI:1588715726
Name:BONOMO, RAYMOND ARTHUR (DMD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:ARTHUR
Last Name:BONOMO
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 1:424 RAY NORRISH DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-1520
Mailing Address - Country:US
Mailing Address - Phone:513-671-0222
Mailing Address - Fax:513-671-0256
Practice Address - Street 1:424 RAY NORRISH DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-1520
Practice Address - Country:US
Practice Address - Phone:513-671-0222
Practice Address - Fax:513-671-0256
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0214491223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics