Provider Demographics
NPI:1588798375
Name:BONILLA, HUGO A (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:HUGO
Middle Name:A
Last Name:BONILLA
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:3299 WOODBURN RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1275
Mailing Address - Country:US
Mailing Address - Phone:703-560-2672
Mailing Address - Fax:703-560-2674
Practice Address - Street 1:3299 WOODBURN RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1275
Practice Address - Country:US
Practice Address - Phone:703-560-2672
Practice Address - Fax:703-560-2674
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA04014103351223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics