Healthcare Provider Details

I. General information

NPI: 1497526677
Provider Name (Legal Business Name): TUTKU DENIZ BONHAM II DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BEULAH RD NE STE 120
VIENNA VA
22180-4745
US

IV. Provider business mailing address

1010 PALESTINE WY STE #6
PATERSON NJ
07503
US

V. Phone/Fax

Practice location:
  • Phone: 703-938-2000
  • Fax:
Mailing address:
  • Phone: 862-378-3266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401419969
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: