Organization
CHRISTOPHER E. BONACCI DDS MD PC
Active
Organization
CHRISTOPHER E. BONACCI DDS MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER EUGENE BONACCI DDS MD (PRESIDENT)
(703) 255-9400
Entity
Organization
Contact information
Practice address
361 MAPLE AVE W, SUITE 200, VIENNA, VA 22180-4304
(703) 255-9400
Mailing address
361 MAPLE AVE W, SUITE 200, VIENNA, VA 22180-4304
(703) 255-9400
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
0101057525
VA
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
0401102631
VA
Other
Enumeration date
07/18/2006
Last updated
09/23/2011
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