Timothy D Bonniwell, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

053673-1 Issued in NY

Practice address

2377 N Triphammer Rd
Ithaca, NY 14850-1050

Phone

(607) 266-8600

Fax

(607) 266-8603

NPI assigned

Jan 3, 2006

Last updated

Sep 22, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 3, 2013 through Jan 3, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1136246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1386622173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2377 N TRIPHAMMER RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501050",
            "telephone_number": "607-266-8600",
            "fax_number": "607-266-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2377 N TRIPHAMMER RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148501050",
            "telephone_number": "607-266-8600",
            "fax_number": "607-266-8603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNIWELL",
        "first_name": "TIMOTHY",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-03",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NY",
            "license": "053673-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mashhood Ahmad Bodla, MBBS
• Wade S Bollinger, M.D.
• Brian Bollo, MD
• Lizette Bonilla
• Elizabeth Bonini-Stewart, RN
• Deana Bonno, M.D.
• Carol Blood Booth
• Carolina F Borden, LCSW
• Emily Louise Bordlemay
• Vanessa Borotz

• Oral and Maxillofacial Surgery (Dentist) in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.