Individual
DR. FREDRIC L BONINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MS, PC
Contact information
Practice address
6893 GRAND RIVER RD, BRIGHTON, MI 48114-9345
(810) 229-9180
(810) 229-1880
Mailing address
6893 GRAND RIVER RD, BRIGHTON, MI 48114-9345
(810) 229-9180
(810) 229-1880
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
2910112106
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184980914
SOLE PROPRIETOR NPI
MI
Enumeration date
06/30/2006
Last updated
05/22/2012
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