Justin Bonvallet, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019027531 Issued in IL

Practice address

132 N Walnut St
Byron, IL 61010-8807

Phone

(815) 234-4211

NPI assigned

Nov 10, 2006

Sex

Male

Sole proprietor

No

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 IL

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

Practice roles

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.

• Bonvallet Dental, PC

  • Dental Clinic/Center
  • Byron, IL
  • NPI 1912265133
  NPD (past) Authorized official

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

{
    "created_epoch": "1163116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295308800000",
    "number": "1316018708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 N WALNUT ST",
            "city": "BYRON",
            "state": "IL",
            "postal_code": "610108807",
            "telephone_number": "815-234-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 N WALNUT ST",
            "city": "BYRON",
            "state": "IL",
            "postal_code": "610108807",
            "telephone_number": "815-234-4211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONVALLET",
        "first_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-10",
        "last_updated": "2011-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6041",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Callianne Marie Beach, M.A., CCC-SLP
• Best Life Therapy PLLC
• Kristyn Bielskis, SPEECH-LANGUAGE PATH
• Mallory N Blassingham, DPT
• Bonvallet Dental, PC
• Amy S Brass, EDS
• Arthur J Breck, MD
• Rachel Eleanor Bridges
• Wendy Bulthuis-Susong
• Jeremy Buttram, PTA

• Dentist in Byron, IL
• Providers in Byron, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2011; 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.