Bonney Lake Oral Surgery

Primary specialty

DentistTaxonomy code 122300000X

License

DE00008264 Issued in WA

Legal business name

BONNEY LAKE ORAL SURGERY

Practice address

8412 Myers Rd
Suite 101
Bonney Lake, WA 98391-5112

Phone

(253) 863-2200

Fax

(253) 447-4968

NPI assigned

Apr 12, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Rosa Maria Cortesi

Title

Office Manager

Phone

(253) 863-2200

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1235353392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8412 MYERS RD",
            "address_2": "SUITE 101",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983915112",
            "telephone_number": "253-863-2200",
            "fax_number": "253-447-4968"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8412 MYERS RD",
            "address_2": "SUITE 101",
            "city": "BONNEY LAKE",
            "state": "WA",
            "postal_code": "983915112",
            "telephone_number": "253-863-2200",
            "fax_number": "253-447-4968"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BONNEY LAKE ORAL SURGERY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CORTESI",
        "authorized_official_first_name": "ROSA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "253-863-2200"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "DE00008264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bonney Lake Dental LLC (Comfort Dental Bonney Lake)
• Bonney Lake Family Dentistry, PLLC (Bonney Lake Family Dentistry)
• Bonney Lake Medical Center
• Bonney Lake Optical, Inc (Emerald Eye Care)
• Bonney Lake Optical, Inc (Spanaway Lake Optical)
• Bonney Lake Pharmacy, LLC (Bonney Lake Pharmacy)
• Bonney Lake Physical Therapy and Hand Rehab, PLLC
• Billy Boraphet
• Kathleen G Borgstrom, LMP
• Julie Dyan Botsford, L.M.P.

• Dentist in Bonney Lake, WA
• Providers in Bonney Lake, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.