Kelly A Buoniconti, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

31847 Issued in TX

Practice address

26112 Overlook Pkwy
Ste 1108
San Antonio, TX 78260-6051

Phone

(210) 293-0810

NPI assigned

Feb 10, 2016

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1455062400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465257600000",
    "number": "1164880787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4416 N MOODY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606303007",
            "telephone_number": "773-580-9827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26112 OVERLOOK PKWY",
            "address_2": "STE 1108",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782606051",
            "telephone_number": "210-293-0810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUONICONTI",
        "first_name": "KELLY",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-10",
        "last_updated": "2016-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "OH",
            "license": "RES.3571",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "31847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Geoffrey Harry Buncke, M.D.
• Jamie Marie Bundeson, LMFT
• Lizette Bunn, PHARMD
• Paulette Scott Bunton, M.D.
• John Buoniconti, D.C
• Hayley Dolan Buratowski, PA
• Keith M. Burau, M.D.
• Paige Camille Burau, MSN, APRN, FNP-C
• Andrea Dawn Burbank, MD
• Charles J Burch, MD

• Dentist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.