Individual
DR. KELLY A BUONICONTI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.M.D.
Contact information
Practice address
26112 OVERLOOK PKWY, STE 1108, SAN ANTONIO, TX 78260-6051
(210) 293-0810
Mailing address
4416 N MOODY AVE, CHICAGO, IL 60630-3007
(773) 580-9827
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
31847
TX
390200000X
Student in an Organized Health Care Education/Training Program
RES.3571
OH
Other
Enumeration date
02/10/2016
Last updated
06/07/2016
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