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General NPI Number Information
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NPI Number | 1003270612
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Entity Type | Individual
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Provider Name | DOMINIQUE BONNER DDS
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Gender | Female
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Dates
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Enumeration Date | 04/09/2016
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 9547A FAIRFAX BLVD
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City | FAIRFAX
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State | VA
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Zip | 22031-4740
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Country | US
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Telephone | 703-520-9985
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Fax |
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Provider Business Mailing Address
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Address Line | 9547A FAIRFAX BLVD
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City | FAIRFAX
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State | VA
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Zip | 22031-4740
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Country | US
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Telephone | 703-520-9985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 16313
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16313
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 0401415681
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License Number State | VA
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