Organization
FREDRIC L. BONINE, DDS, MS, PC
Active
Parent organization
DR. FREDRIC L. BONINE, DDS, MS, PC
Other names
Fredric L. Bonine, DDS, MS, PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DR. FREDRIC L. BONINE, DDS, MS, PC
Authorized official
DR. FREDRIC L. BONINE DDS, MS, PC (SOLE PROPRIETOR)
(810) 229-9180
Entity
Organization
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
305R00000X
Preferred Provider Organization
Primary
2901012106
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1063440543
INDIVIDUAL NPI
MI
Enumeration date
04/05/2012
Last updated
05/22/2012
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