Provider Demographics
NPI:1730393968
Name:BONTA, CARMEN YOLANDA (DMD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:YOLANDA
Last Name:BONTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-4206
Mailing Address - Country:US
Mailing Address - Phone:732-873-0117
Mailing Address - Fax:
Practice Address - Street 1:53 BAYBERRY DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-4206
Practice Address - Country:US
Practice Address - Phone:732-873-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI16933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist