Bonnie Jean Devall, LICENSED DENTURIST

Primary specialty

DenturistTaxonomy code 122400000X

License

LD18 Issued in ID

Practice address

507 Main Ave W
Suite B
Twin Falls, ID 83301

Phone

(208) 733-2374

NPI assigned

Jan 30, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720124324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 MAIN AVE W SUITE B",
            "address_2": "MAIN WEST DENTURE CLINIC",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "83301",
            "telephone_number": "208-733-2374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "507 MAIN AVE W",
            "address_2": "SUITE B",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "83301",
            "telephone_number": "208-733-2374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEVALL",
        "first_name": "BONNIE",
        "middle_name": "JEAN",
        "name_prefix": "Mrs.",
        "credential": "LICENSED DENTURIST",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "",
            "desc": "Denturist",
            "state": "ID",
            "license": "LD18",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001191300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jarom Andrew Denton, PA-C
• Christopher Depman
• Patrick P Desmond, M.D.
• Kayler Detmer
• Heather Marie Deuel, LCSW
• Kathryn Devaney, FNP-C, PMHNP-BC
• Jason B Devries, DPM
• Kelcie Dickerson, PA
• Dale Dickinson, CRNA
• Digestive Health Services, LTD

• Denturist in Twin Falls, ID
• Providers in Twin Falls, ID by specialty
• Denturist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.