Individual
MICHELLE BONGIOVI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
113 LIELMANIS AVE, HURLBURT FIELD, FL 32544-5613
(850) 884-7881
Mailing address
HURLBURT FIELD, BLDG 91202,, DPO, AA 32544
(850) 884-7881
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
3070
NV
1223P0300X
Periodontics
Primary
S4-19
NV
Other
Enumeration date
04/25/2007
Last updated
04/20/2026
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