Provider Demographics
NPI:1780751743
Name:DEBONIS, JOHN B
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:B
Last Name:DEBONIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:PA
Mailing Address - Zip Code:15202-3629
Mailing Address - Country:US
Mailing Address - Phone:412-761-9594
Mailing Address - Fax:412-766-0495
Practice Address - Street 1:467 LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:PA
Practice Address - Zip Code:15202
Practice Address - Country:US
Practice Address - Phone:412-761-9594
Practice Address - Fax:412-766-0495
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0254747L1223X2210X
PADS025747 L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty
No122300000XDental ProvidersDentist