Individual
DR. TANYA BONICELLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
4302 13TH AVE S, FARGO, ND 58103-3395
(701) 277-3269
(701) 277-4994
Mailing address
4302 13TH AVE S, FARGO, ND 58103-3395
(701) 277-3269
(701) 277-4994
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2027
ND
Other
Enumeration date
06/23/2008
Last updated
10/27/2008
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