Organization
DRS BONASSO AND KIME PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRANKLIN DAVID BONASSO D.D.S. (OWNER)
(304) 366-9833
Entity
Organization
Contact information
Practice address
100 GREENBRIER PLAZA, FAIRMONT, WV 26554
(304) 366-9833
Mailing address
100 GREENBRIER PLAZA, FAIRMONT, WV 26554
(304) 366-9833
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0134750000
—
WV
01
—
163857
UNITED CONCORDIA
WV
Enumeration date
08/18/2008
Last updated
04/02/2013
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