Individual
DR. DOMINIQUE BONNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
9547A FAIRFAX BLVD, FAIRFAX, VA 22031-4740
(703) 520-9985
Mailing address
9547A FAIRFAX BLVD, FAIRFAX, VA 22031-4740
(703) 520-9985
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401415681
VA
122300000X
Dentist
16313
MD
1223G0001X
General Practice Dentistry
16313
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
019031088
IL DENTAL LICENSE #
IL
01
—
0401415681
VA DENTAL LICENSE #
VA
01
—
16313
MD DENTAL LICENSE #
MD
Enumeration date
04/09/2016
Last updated
07/25/2022
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