Provider Demographics
NPI:1730335167
Name:DRS BONASSO AND KIME PLLC
Entity type:Organization
Organization Name:DRS BONASSO AND KIME PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BONASSO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-366-9833
Mailing Address - Street 1:100 GREENBRIER PLAZA
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554
Mailing Address - Country:US
Mailing Address - Phone:304-366-9833
Mailing Address - Fax:
Practice Address - Street 1:100 GREENBRIER PLAZA
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554
Practice Address - Country:US
Practice Address - Phone:304-366-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-18
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV163857OtherUNITED CONCORDIA
WV0134750000Medicaid