Individual
DIEGO ALBERTO BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTAL ASSISTANT
Contact information
Practice address
7305 NORTH MILITARY TRAIL, WEST PALM BEACH, FL 33410
(561) 422-7734
Mailing address
2544 NW 98TH WAY, CORAL SPRINGS, FL 33065-4960
(305) 394-1578
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
DR 129942
ZZ
Other
Enumeration date
12/28/2012
Last updated
12/28/2012
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