Steven Anthony Bonomo, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS 030178 L Issued in PA

Practice address

369 S Main St
Wilkes Barre, PA 18701-2202

Phone

(570) 829-7863

Fax

(570) 822-7478

NPI assigned

Oct 18, 2006

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 21, 2021 through Jul 21, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Farris and Moll PC

  • Dentist
  • Red Hill, PA
  • NPI 1417084336
  NPD (past)
• Michael Bonomo, DMD, LLC

  • Public Health Dentistry
  • Red Hill, PA
  • NPI 1295073914
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1003997834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "369 S MAIN ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187012202",
            "telephone_number": "570-829-7863",
            "fax_number": "570-822-7478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "369 S MAIN ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187012202",
            "telephone_number": "570-829-7863",
            "fax_number": "570-822-7478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONOMO",
        "first_name": "STEVEN",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS 030178 L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00016528190002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly M Bolesta, PHARM.D.
• Joseph John Bolinsky III, PA-C
• Kavita S Bommasamudram, MD
• Gary Bonfante, DO
• Joann Bonn, PHARMD
• Rebecca Marie Boran, PTA
• Jacob Patrick Borkowski
• Jennifer Marie Borowski, PHARMD
• Bollaiah Borra, M.D.
• Sarah Bottger, RDN

• General Practice Dentistry in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.