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Organization
ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION
Active
Organization
ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION
Active
Other names
Cosmetic Implant Gold Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ESTEBAN D BONILLA D.D.S. (DENTIST / OWNER)
(818) 980-2887
Entity
Organization
Contact information
Practice address
10745 RIVERSIDE DRIVE, SUITE B, TOLUCA LAKE, CA 91602
(818) 980-2887
(818) 980-2807
Mailing address
10745 RIVERSIDE DRIVE, SUITE B, TOLUCA LAKE, CA 91602
(818) 980-2887
(818) 980-2807
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
36135
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B36135
MEDI-CAL PIN
CA
Enumeration date
07/19/2007
Last updated
07/19/2007
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