Provider Demographics
NPI:1902026123
Name:BONILLA-VOSBURGH, ELVIRA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:P
Last Name:BONILLA-VOSBURGH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 17TH ST NW STE 205
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2494
Mailing Address - Country:US
Mailing Address - Phone:202-332-0044
Mailing Address - Fax:202-332-1951
Practice Address - Street 1:1700 17TH ST NW STE 205
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2494
Practice Address - Country:US
Practice Address - Phone:202-332-0044
Practice Address - Fax:202-332-1951
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN44281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice