Provider Demographics
NPI:1285985861
Name:BRONSON, JAMES ALEXANDER (DMD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALEXANDER
Last Name:BRONSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:J.
Other - Middle Name:ALEX
Other - Last Name:BRONSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:6800 FLEETWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3620
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6800 FLEETWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3620
Practice Address - Country:US
Practice Address - Phone:703-506-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-24
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401413680122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist