Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 5169 | LA |
NPI | 1063638054 |
---|---|
Provider Name | Dr. Scott E Bonson |
First Address | Slidell, LA 70461-4179 |
Second Address | Slidell, LA 70461-4179 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 28/04/2008 |