Provider Demographics
NPI:1053567024
Name:ANTHONY, BONNYE R (DDS)
Entity type:Individual
Prefix:DR
First Name:BONNYE
Middle Name:R
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 RIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-1365
Mailing Address - Country:US
Mailing Address - Phone:919-667-1680
Mailing Address - Fax:919-667-1684
Practice Address - Street 1:1208 RIDDLE RD
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-1365
Practice Address - Country:US
Practice Address - Phone:919-667-1680
Practice Address - Fax:919-667-1684
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7100122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist