Bonanza Square Dentistry LLC
Bonanza Square Dentistry LLC is a healthcare organization registered as General Practice Dentistry in Payson, AZ, holding Type 2 (organization) NPI 1104019918 since 2007. The authorized official on file is Eldon Jenkins, Owner.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1104019918 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Bonanza Square Dentistry LLC |
| Practice address | 200 W FRONTIER ST, SUITE 5, Payson, AZ, 85541 |
| Phone | 9284722500 |
| Fax | 9284726699 |
| Enumeration date | 2007-08-24 |
| Last updated in NPPES | 2007-08-24 |
Authorized official
| Name | Eldon Jenkins |
|---|---|
| Title | Owner |
| Phone | 4802052476 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 1223G0001X | General Practice Dentistry | Primary | D5797 | AZ |
Copy-ready billing details
Provider: Bonanza Square Dentistry LLC NPI: 1104019918 Taxonomy: 1223G0001X (General Practice Dentistry) Address: 200 W FRONTIER ST, SUITE 5, Payson, AZ, 85541
Providers at this address
| NPI | Name | Type | Specialty | Location |
|---|---|---|---|---|
| 1962425389 | Deborah Nichols | Individual | Family Nurse Practitioner | Payson, AZ |
| 1831327238 | Benjamin Mcdowell | Individual | Orthodontics and Dentofacial Orthopedics Dentistry | Payson, AZ |
| 1477858801 | Dan Nurse Practitioner Services, LLC | Organization | Primary Care Nurse Practitioner | Payson, AZ |
Verify this record
Cross-check NPI 1104019918 against the authoritative CMS record: view Bonanza Square Dentistry LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Bonanza Square Dentistry LLC?
Who is the authorized official for Bonanza Square Dentistry LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2007-08-24.