Dominique Bonner, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

0401415681 Issued in VA

Practice address

9547A Fairfax Blvd
Fairfax, VA 22031-4740

Phone

(703) 520-9985

NPI assigned

Apr 9, 2016

Last updated

Jul 25, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Dr. Dominique Knox Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Johnson and Knox Dentcare Associates

  dba Dentcare Now

  • General Practice Dentistry
  • Fairfax, VA
  • NPI 1154987360
  NPD
• Larosiliere and Associates Dental Care, PA

  dba Capitol Dental Associates

  • General Practice Dentistry
  • Washington, DC
  • NPI 1588221030
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1460160000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1003270612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9547A FAIRFAX BLVD",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314740",
            "telephone_number": "703-520-9985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9547A FAIRFAX BLVD",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314740",
            "telephone_number": "703-520-9985"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "83 High St",
            "address_purpose": "LOCATION",
            "city": "Waldorf",
            "state": "MD",
            "postal_code": "206022190",
            "country_code": "US",
            "telephone_number": "301-645-3601",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 S Capitol St SW Ste B",
            "address_purpose": "LOCATION",
            "city": "Washington",
            "state": "DC",
            "postal_code": "200033529",
            "country_code": "US",
            "telephone_number": "202-621-8446",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5805 Silver Hill Rd",
            "address_purpose": "LOCATION",
            "city": "District Heights",
            "state": "MD",
            "postal_code": "207471170",
            "country_code": "US",
            "telephone_number": "301-568-8444",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONNER",
        "first_name": "DOMINIQUE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-04-09",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MD",
            "license": "16313",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401415681",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "16313",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD DENTAL LICENSE #",
            "identifier": "16313",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL DENTAL LICENSE #",
            "identifier": "019031088",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA DENTAL LICENSE #",
            "identifier": "0401415681",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "dentcarenow.com",
            "affiliation": "Y",
            "affiliationName": "Johnson and Knox Dentcare Associates",
            "address_1": "9547A Fairfax Blvd",
            "city": "Fairfax",
            "state": "VA",
            "country_code": "US",
            "postal_code": "220314740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "DOMINIQUE",
            "last_name": "KNOX",
            "prefix": "DR.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jean Bond, LCSW
• Bone Densitometry Center
• Anna Bonicky, PA-C
• Maria Bonilla, LCSW
• Samantha Lynne Bonito, PT, DPT
• Elyssa Bonner
• Jennifer Candace Bonner, MS
• Rose Bonner, RN
• Jason Andrew Bonomo, MD, PHD
• Katherine Booker, PT

• Dentist in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.