Provider Demographics
NPI:1558370320
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:MERRITT
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-506-9805
Mailing Address - Street 1:6800 FLEETWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3604
Mailing Address - Country:US
Mailing Address - Phone:703-506-9805
Mailing Address - Fax:
Practice Address - Street 1:6800 FLEETWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3604
Practice Address - Country:US
Practice Address - Phone:703-506-9805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006161261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental