Provider Demographics
NPI:1366054223
Name:ONDO BENGONE, IRIA A (DDS)
Entity type:Individual
Prefix:
First Name:IRIA
Middle Name:A
Last Name:ONDO BENGONE
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 1:7903 ORION CIR # C328
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-3101
Mailing Address - Country:US
Mailing Address - Phone:832-213-6429
Mailing Address - Fax:
Practice Address - Street 1:7903 ORION CIR # C328
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20724-3101
Practice Address - Country:US
Practice Address - Phone:832-213-6429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program