Organization
BONVALLET FAMILY DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANNA M BONVALLET DMD (OWNER)
(815) 239-1313
Entity
Organization
Contact information
Practice address
727 MAIN ST, PECATONICA, IL 61063-7740
(815) 239-1313
Mailing address
727 MAIN ST, PO BOX 608, PECATONICA, IL 61063-7740
(815) 239-1313
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019016389
IL
Other
Enumeration date
01/23/2017
Last updated
01/23/2017
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