Provider Demographics
NPI:1255683751
Name:JAMES M BRONSON, DDS, PC
Entity Type:Organization
Organization Name:JAMES M BRONSON, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-202-7125
Mailing Address - Street 1:4954 OLD DOMINION DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207-2854
Mailing Address - Country:US
Mailing Address - Phone:703-506-9805
Mailing Address - Fax:
Practice Address - Street 1:3054 BERKMAR DR
Practice Address - Street 2:UNIT A
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-3407
Practice Address - Country:US
Practice Address - Phone:434-202-7125
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006161261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental