Provider Demographics
NPI:1902046782
Name:DENNIS J BUONO DO INC
Entity type:Organization
Organization Name:DENNIS J BUONO DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:BUONO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-732-9975
Mailing Address - Street 1:2621 E HARBOR RD
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2607
Mailing Address - Country:US
Mailing Address - Phone:419-732-9975
Mailing Address - Fax:419-732-6415
Practice Address - Street 1:2621 E HARBOR RD
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2607
Practice Address - Country:US
Practice Address - Phone:419-732-9975
Practice Address - Fax:419-732-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008701207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2634466Medicaid
OHH99014Medicare UPIN
OHBU4177961Medicare PIN