Healthcare Provider Details

I. General information

NPI: 1366054223
Provider Name (Legal Business Name): IRIA A ONDO BENGONE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7903 ORION CIR # C328
LAUREL MD
20724-3101
US

IV. Provider business mailing address

7903 ORION CIR # C328
LAUREL MD
20724-3101
US

V. Phone/Fax

Practice location:
  • Phone: 832-213-6429
  • Fax:
Mailing address:
  • Phone: 832-213-6429
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number17729
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: