Provider Demographics
NPI:1679888564
Name:BONGIORNO, WILLIAM W (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:W
Last Name:BONGIORNO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1278 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11228-1505
Mailing Address - Country:US
Mailing Address - Phone:718-680-1117
Mailing Address - Fax:718-491-5536
Practice Address - Street 1:1278 72ND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11228-1505
Practice Address - Country:US
Practice Address - Phone:718-680-1117
Practice Address - Fax:718-491-5536
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-16
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0303971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice