Bryan Edward Bonnet, DDS – General Practice Dentistry

Key facts

NPI: 1144217985
Entity type: Individual (NPI type 1)
Primary specialty: General Practice Dentistry 1223G0001X
License: 5456 (OK)
Practice address: 12195 S Yukon Ave
Glenpool, OK 74033-6621
Phone: (918) 322-9445
NPI assigned: Oct 5, 2005
Sex: Male
Sole proprietor: No

Organizations & group practices 1

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

Bryan E Bonnet DDS PC Inc Dental Clinic/Center · Glenpool, OK · NPI 1356067474

NPD

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

Practice roles

Organization	Specialty	Status	New patients
Bryan E Bonnet DDS PC Inc		Current since Oct 23, 2022	Accepting new patients

Locations

12195 S Yukon Ave
Glenpool, OK 74033
Phone (918) 322-9445

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Dentist	122300000X	5456	OK
General Practice Dentistry	1223G0001X	5456	OK	Yes

Addresses

Primary practice location

12195 S Yukon Ave
Glenpool, OK 74033-6621

Mailing address

12195 S Yukon Ave
Glenpool, OK 74033-6621
Phone (918) 322-9445

Other identifiers

Identifier	Type	State	Issuer
100255520A	Medicaid	OK

Other providers in Glenpool, OK

All providers in Glenpool, OK · General Practice Dentistry in Oklahoma

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 18, 2022. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.