Provider Demographics
NPI:1962416552
Name:BONAMER, THERESE M (DDS)
Entity type:Individual
Prefix:DR
First Name:THERESE
Middle Name:M
Last Name:BONAMER
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 1:13477 PROSPECT RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-3867
Mailing Address - Country:US
Mailing Address - Phone:440-572-5437
Mailing Address - Fax:
Practice Address - Street 1:13477 PROSPECT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44149-3867
Practice Address - Country:US
Practice Address - Phone:440-572-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0183641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry