Individual
DR. WILLIAM W BONIFANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1003 SUSHRUTA DR, MARTINSBURG, WV 25401
(304) 263-3367
(304) 263-1634
Mailing address
160 IROQUOIS TRAIL, MARTINSBURG, WV 25401
(304) 267-2327
(304) 263-1634
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2433
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0136266000
—
WV
01
—
122370
UNITED CONCORDIA
WV
01
—
140437
ANTHEM BCBS
VA
Enumeration date
08/30/2006
Last updated
07/08/2007
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