OrganizationActive
Bonanza Square Dentistry LLC
NPI 1104019918 · General Practice Dentistry · Payson, AZ
Bonanza Square Dentistry LLC is a General Practice Dentistry organization in Payson, AZ (NPI 1104019918).
Provider details
- NPI number
- 1104019918
- Entity type
- Organization
- Primary specialty
- General Practice DentistryDental Providers
- Organization subpart
- No
- Authorized official
- Eldon Jenkins, Owner(480) 205-2476
- License
- D5797 (AZ)
Specialties & taxonomies
Dental Providers
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
200 W Frontier St
Suite 5
Payson, AZ 85541
Phone: (928) 472-2500
Fax: (928) 472-6699
Street-level locationGet directions
Mailing address
200 W Frontier St
Payson, AZ 85541
Registry dates
- Enumerated
- 2007-08-24
- Last updated
- 2007-08-24
Frequently asked questions
- What is Bonanza Square Dentistry LLC's NPI number?
- Bonanza Square Dentistry LLC's National Provider Identifier (NPI) is 1104019918, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Bonanza Square Dentistry LLC?
- Bonanza Square Dentistry LLC is classified in the NPPES registry as General Practice Dentistry (Dental Providers).
- Where is Bonanza Square Dentistry LLC located?
- Bonanza Square Dentistry LLC's practice location on file with NPPES is 200 W Frontier St, Payson, AZ 85541.
- What is Bonanza Square Dentistry LLC's phone number?
- The practice phone number listed in the NPPES registry for Bonanza Square Dentistry LLC is (928) 472-2500.
- Who is the authorized official for Bonanza Square Dentistry LLC?
- The authorized official listed on Bonanza Square Dentistry LLC's NPPES record is Eldon Jenkins, Owner. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Bonanza Square Dentistry LLC's NPI active?
- Yes — Bonanza Square Dentistry LLC's NPI (1104019918) is active in the NPPES registry as of the last update on 2007-08-24.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.