Provider Demographics
NPI:1902931322
Name:BONNICK, BERTRAND A (DDS)
Entity Type:Individual
Prefix:
First Name:BERTRAND
Middle Name:A
Last Name:BONNICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2783 NC HIGHWAY 68 S STE 107
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-8325
Mailing Address - Country:US
Mailing Address - Phone:336-841-0000
Mailing Address - Fax:336-841-0001
Practice Address - Street 1:2783 NC HIGHWAY 68 S STE 107
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8325
Practice Address - Country:US
Practice Address - Phone:336-841-0000
Practice Address - Fax:336-841-0001
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC076721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice