Active NPI
Salvatore Michael Bonanno, DDS
- Endodontics
- New Bedford, MA
National Provider Identifier
1780888313
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 034267
- Practice address
- 137 Hathaway Rd
New Bedford, MA 02746-1304 - Phone
- (914) 747-0231
- Fax
- (914) 747-1953
- NPI assigned
- Jun 14, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 034267 | NY | Primary |
Addresses
Primary practice location
137 Hathaway Rd
New Bedford, MA 02746-1304
Mailing address
1090 Northchase Pkwy SE, Suite 290
Kool Smiles Support Services Office/ NCDR, LLC
Marietta, GA 30067
Phone (678) 904-5665
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034267 | NY | MD | Endodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304380800000",
"number": "1780888313",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1090 NORTHCHASE PKWY SE, SUITE 290",
"address_2": "KOOL SMILES SUPPORT SERVICES OFFICE/ NCDR, LLC",
"city": "MARIETTA",
"state": "GA",
"postal_code": "30067",
"telephone_number": "678-904-5665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "137 HATHAWAY RD",
"city": "NEW BEDFORD",
"state": "MA",
"postal_code": "027461304",
"telephone_number": "914-747-0231",
"fax_number": "914-747-1953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONANNO",
"first_name": "SALVATORE",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-14",
"last_updated": "2011-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "NY",
"license": "034267",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Bedford, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.