Healthcare Provider Details

I. General information

NPI: 1457084964
Provider Name (Legal Business Name): ALYSSA ANGELA BONOMO DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2022
Last Update Date: 07/03/2022
Certification Date: 07/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST NW
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

770 P ST NW APT 302
WASHINGTON DC
20001-2543
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8272
  • Fax:
Mailing address:
  • Phone: 267-733-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: