Provider Demographics
NPI:1902055882
Name:TRAXLER, BONNIE ANN (RDA:RDH)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:ANN
Last Name:TRAXLER
Suffix:
Gender:F
Credentials:RDA:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-686-7607
Mailing Address - Fax:
Practice Address - Street 1:325 RIVER RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-1447
Practice Address - Country:US
Practice Address - Phone:989-686-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902005497124Q00000X
MI2903000569126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant
No124Q00000XDental ProvidersDental Hygienist