Tanya Bonicelli, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2027 Issued in ND

Practice address

4302 13TH Ave S
Fargo, ND 58103-3395

Phone

(701) 277-3269

Fax

(701) 277-4994

NPI assigned

Jun 23, 2008

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Dr B Dentistry PC

  • Dental Clinic/Center
  • Fargo, ND
  • NPI 1104540806
  NPD Authorized official

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225065600000",
    "number": "1770744690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4302 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033395",
            "telephone_number": "701-277-3269",
            "fax_number": "701-277-4994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4302 13TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581033395",
            "telephone_number": "701-277-3269",
            "fax_number": "701-277-4994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONICELLI",
        "first_name": "TANYA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2008-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ND",
            "license": "2027",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bethany Noelle Boman
• Kailey Boman
• Lindsey Ann Bommersbach, RRT
• Melissa Bommersbach, RN
• Robert Allen Bond, DDS
• Janet J Bonn, R.PH.
• Ashlyn Bontje, LSW
• Leah Boock
• Megan Jean Boose, PA-C
• Jill M Booth, SLP

• General Practice Dentistry in Fargo, ND
• Providers in Fargo, ND by specialty
• General Practice Dentistry in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2008; 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.