Provider Demographics
NPI:1861400897
Name:BONI, DEL R (DMD)
Entity type:Individual
Prefix:
First Name:DEL
Middle Name:R
Last Name:BONI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2496 BRODHEAD RD
Mailing Address - Street 2:STE A
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001
Mailing Address - Country:US
Mailing Address - Phone:724-857-0333
Mailing Address - Fax:724-857-0355
Practice Address - Street 1:2496 BRODHEAD RD
Practice Address - Street 2:STE A
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001
Practice Address - Country:US
Practice Address - Phone:724-857-0333
Practice Address - Fax:724-857-0355
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028970L1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics