Individual
CHERYL BONAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11929 VENICE BLVD APT 209, LOS ANGELES, CA 90066-3931
(310) 397-3802
Mailing address
11929 VENICE BLVD APT 209, LOS ANGELES, CA 90066-3931
(310) 397-3802
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0E10717
CA
Other
Enumeration date
11/17/2006
Last updated
07/08/2007
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