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General NPI Number Information
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NPI Number | 1922263391
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Entity Type | Individual
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Provider Name | MARVIN BONFUAN NGWAFON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2008
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Last Update Date | 04/27/2023
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Provider Practice Location Address
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Address Line | 437 CEDAR ST NW
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City | WASHINGTON
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State | DC
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Zip | 20012-1931
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Country | US
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Telephone | 202-725-7735
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Fax |
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Provider Business Mailing Address
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Address Line | 1626 MONTAGUE ST NW
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City | WASHINGTON
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State | DC
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Zip | 20011-2874
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Country | US
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Telephone | 202-550-0633
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 14656
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License Number State | MD
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