Organization
BONANZA SQUARE DENTISTRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELDON DWAYNE JENKINS OWNER (OWNER)
(480) 205-2476
Entity
Organization
Contact information
Practice address
200 W FRONTIER ST, SUITE 5, PAYSON, AZ 85541
(928) 472-2500
(928) 472-6699
Mailing address
200 W FRONTIER ST, SUITE 5, PAYSON, AZ 85541
(928) 472-2500
(928) 472-6699
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5797
AZ
Other
Enumeration date
08/24/2007
Last updated
08/24/2007
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