Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Bonanza Square Dentistry LLC

Organization General Practice Dentistry · NPI 1104019918

Bonanza Square Dentistry LLC is a General Practice Dentistry in Payson, Arizona. Licensed in Arizona. Registered with an NPI since 2007.

Licensed in
AZ
In the registry since
2007
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

200 W Frontier St Ste 5
Payson, AZ 85541
Phone: (928) 472-2500
Fax: (928) 472-6699
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence D5797 (AZ)

Record details

NPI number1104019918
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Eldon Jenkins — Owner · (480) 205-2476
NPI enumeratedAugust 24, 2007
Last updated in NPPESAugust 24, 2007
Mailing address200 W Frontier St, Suite 5, Payson, AZ 85541

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