NPIMap

Organization Active NPI

Bonvallet Dental, PC

  • Dental Clinic/Center
  • Byron, IL
National Provider Identifier
1912265133
Registry record updated Apr 25, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
019027531 Issued in IL
Legal business name
BONVALLET DENTAL, PC
Practice address
132 N Walnut St
Byron, IL 61010-8807
Phone
(815) 234-4211
NPI assigned
Apr 25, 2012
Last updated
Apr 25, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2012

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

Authorized official

Name
Dr. Justin Bonvallet, DMDNPI 1316018708
Title
Dentist/President
Phone
(815) 234-4211

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 019027531 IL Primary

Addresses

Primary practice location

132 N Walnut St
Byron, IL 61010-8807

Mailing address

132 N Walnut St
PO Box 432
Byron, IL 61010-8807
Phone (815) 234-4211

National Provider Directory

National Provider Directory

Locations

132 N Walnut St
Byron, IL 61010
Phone (815) 234-4211

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1335312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335312000000",
    "number": "1912265133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "132 N WALNUT ST",
            "address_2": "PO BOX 432",
            "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": {
        "organization_name": "BONVALLET DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-25",
        "last_updated": "2012-04-25",
        "status": "A",
        "authorized_official_last_name": "BONVALLET",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "DENTIST/PRESIDENT",
        "authorized_official_telephone_number": "815-234-4211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "IL",
            "license": "019027531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Byron, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2012; 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.