Individual
DR. ANDREA MARIE BONNICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2041 GEORGIA AVE NW, SUITE 4C-46, WASHINGTON, DC 20060-0001
(202) 865-1361
(202) 865-3323
Mailing address
15150 PAWLEYS PL, WALDORF, MD 20601-5419
(202) 865-1361
(202) 865-3323
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN5626
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0802270
—
DC
01
—
4833
BLUECROSSBLUE SHIELD
DC
Enumeration date
03/20/2007
Last updated
07/08/2007
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