Individual
DR. MARTIN C BONACORSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
563 COLONIAL DR, BATON ROUGE, LA 70806
(225) 924-6154
(225) 924-6154
Mailing address
563 COLONIAL DR, BATON ROUGE, LA 70806
(225) 924-6154
(225) 924-1058
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
LA1490
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LA1490
DENTIST
LA
Enumeration date
08/27/2006
Last updated
07/08/2007
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