BONANZA SQUARE DENTISTRY LLC
NPI 1104019918
Dentist - General Practice in Payson, AZ

Q: What is Bonanza Square Dentistry LLC's NPI number?

The NPI number for Bonanza Square Dentistry LLC is 1104019918. It was assigned to this organization in the NPPES registry on August 24, 2007.

Q: What is Bonanza Square Dentistry LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Active since August 24, 2007

200 W FRONTIER ST, SUITE 5, PAYSON, AZ 85541(928) 472-2500(928) 472-6699 Get Directions Write a Review

NPPES record last updated: August 24, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Bonanza Square Dentistry Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BONANZA SQUARE DENTISTRY LLC (NPI 1104019918) is a healthcare organization registered as a general practice in Payson, Arizona and active in the NPI registry since August 2007. The organization lists Eldon Dwayne Jenkins, Owner, as its authorized official.

NPPES Registry Identity

NPI1104019918

Entity TypeOrganization

Primary Taxonomy1223G0001X

Legal Business NameBONANZA SQUARE DENTISTRY LLC

Location Address200 W FRONTIER ST, SUITE 5Payson, AZ 85541

Mailing Address200 W Frontier St, Suite 5Payson, AZ 85541 · (928) 472-2500 · Fax (928) 472-6699

Phone(928) 472-2500

Fax(928) 472-6699

Organization SubpartNo

Authorized OfficialEldon Dwayne JenkinsOwner · (480) 205-2476

Enumeration DateAugust 24, 2007

✔ NPI 1104019918 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in AZ · D5797

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

200 W FRONTIER ST, Payson, AZ 85541

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DAN NURSE PRACTITIONER SERVICES, LLC

Nurse Practitioner (Primary Care)

200 W FRONTIER ST, SUITE M
PAYSON, AZ 85541

Gila County (928) 595-1176

DR. BENJAMIN D MCDOWELL D.D.S.

Dentist (Orthodontics and Dentofacial Orthopedics)

200 W FRONTIER ST, SUITE 5
PAYSON, AZ 85541

Gila County (928) 472-7223

MS. DEBORAH ANN NICHOLS FNP

Nurse Practitioner (Family)

200 W FRONTIER ST, SUITE M
PAYSON, AZ 85541

Gila County (928) 478-6280

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Bonanza Square Dentistry LLC's NPI number?

The NPI number for Bonanza Square Dentistry LLC is 1104019918. It was assigned to this organization in the NPPES registry on August 24, 2007.

Where is Bonanza Square Dentistry LLC located?

Bonanza Square Dentistry LLC is located at 200 W Frontier St Suite 5, Payson, AZ 85541. The listed phone number is (928) 472-2500.

What is Bonanza Square Dentistry LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Bonanza Square Dentistry LLC was last updated on August 24, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.