Bonanza Square Dentistry LLC
NPI 1104019918ActiveOrganization· Dentist, General Practice· Payson, AZ
Dentist, General Practice in Payson, Arizona, registered in NPPES in August 2007. The authorized official on file is Eldon Dwayne Jenkins, OWNER, Owner.
Overview
| NPI | 1104019918 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 24, 2007 |
| Last updated in NPPES | Aug 24, 2007 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dentist, General Practice Primary | 1223G0001X | D5797 | AZ |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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