Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901020237 | MI |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 4301105945 | MI |
NPI | 1447679444 |
---|---|
Provider Name | Dr. Jonathan Bonnet |
First Address | Battle Creek, MI 49015-9354 |
Second Address | Battle Creek, MI 49015-9354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2014 |
Last Update Date | 14/05/2020 |