Most Relevant Information
Provider Data
| NPI Number: | 1003270612 |
| Provider Name: | DOMINIQUE BONNER DDS |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 16313 |
Most Important Dates
| Enumeration Date: | 04/09/2016 |
| Last Updated: | 07/25/2022 |
Provider Practice Location
9547A FAIRFAX BLVD
FAIRFAX
VA
220314740
Practice Location Phone/Fax
| Phone: | 7035209985 |
| Fax: |
Provider Mailing Location
9547A FAIRFAX BLVD
FAIRFAX
VA
220314740
Provider Mailing Phone/Fax
| Phone: | 7035209985 |
| Fax: |