Provider Demographics
NPI:1659514172
Name:MATTHYSSE, BONNY KAYE (RDH)
Entity type:Individual
Prefix:MRS
First Name:BONNY
Middle Name:KAYE
Last Name:MATTHYSSE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3185 CORPORATE GROVE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8021
Mailing Address - Country:US
Mailing Address - Phone:606-896-7600
Mailing Address - Fax:616-896-8724
Practice Address - Street 1:3185 CORPORATE GROVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8021
Practice Address - Country:US
Practice Address - Phone:606-896-7600
Practice Address - Fax:616-896-8724
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902005277124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist