Individual
DR. JUSTIN BONVALLET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
132 N WALNUT ST, BYRON, IL 61010-8807
(815) 234-4211
Mailing address
132 N WALNUT ST, BYRON, IL 61010-8807
(815) 234-4211
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019027531
IL
122300000X
Dentist
6041
WI
Other
Enumeration date
11/10/2006
Last updated
01/18/2011
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