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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