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Organization
BONVALLET DENTAL, PC
Active
Organization
BONVALLET DENTAL, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN BONVALLET DMD (DENTIST/PRESIDENT)
(815) 234-4211
Entity
Organization
Contact information
Practice address
132 N WALNUT ST, BYRON, IL 61010-8807
(815) 234-4211
Mailing address
132 N WALNUT ST, PO BOX 432, BYRON, IL 61010-8807
(815) 234-4211
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019027531
IL
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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