Provider Demographics
NPI:1851513386
Name:BONFIGLIO, THOMAS C (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:C
Last Name:BONFIGLIO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-1004
Mailing Address - Country:US
Mailing Address - Phone:410-268-5503
Mailing Address - Fax:410-268-5545
Practice Address - Street 1:1606 FOREST DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-1004
Practice Address - Country:US
Practice Address - Phone:410-268-5503
Practice Address - Fax:410-268-5545
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD105841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice