Joseph Davin Bonavilla, D.D.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

4305 Issued in SC

Practice address

888 Cook Rd
Orangeburg, SC 29118-2126

Phone

(803) 516-0777

Fax

(803) 516-0577

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

• Central Carolina Endodontics PA

  • Endodontics
  • Orangeburg, SC
  • NPI 1710442967
  NPD (past) Authorized official

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191888000000",
    "number": "1205045382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 COOK RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291182126",
            "telephone_number": "803-516-0777",
            "fax_number": "803-516-0577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 COOK RD",
            "city": "ORANGEBURG",
            "state": "SC",
            "postal_code": "291182126",
            "telephone_number": "803-516-0777",
            "fax_number": "803-516-0577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONAVILLA",
        "first_name": "JOSEPH",
        "middle_name": "DAVIN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "SC",
            "license": "4305",
            "primary": true
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "GA",
            "license": "DN013507",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "NY",
            "license": "50-051910",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "WV",
            "license": "3516",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "VA",
            "license": "0401411675",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerard Kevin Blanchard Sr., LICENSED OPTICIAN
• Kevin L. Blanchard, CRNA
• Laura R Blankenship
• Monica Liliane Blundell Osorio
• Yaw Boateng, R.D., C.D.E.
• Annie Samantha Bonnette, CCC-SLP
• Courtney Davis Bordenkecher, DPM
• Henry Bowens Jr., MD
• Penelope Jean Bowman, CNM
• Kezia Boyd, MA

• Endodontics in Orangeburg, SC
• Providers in Orangeburg, SC by specialty
• Endodontics in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.