Esteban D Bonilla, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

36135 Issued in CA

Practice address

10745 Riverside Drive
Suite B
Toluca Lake, CA 91602-2371

Phone

(818) 980-2887

Fax

(818) 980-2807

NPI assigned

May 1, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Esteban D. Bonilla DDS Professional Corporation

  dba Cosmetic Implant Gold Dental Center

  • Dental Clinic/Center
  • Toluca Lake, CA
  • NPI 1356541361
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1114148723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10745 RIVERSIDE DRIVE",
            "address_2": "SUITE B",
            "city": "TOLUCA LAKE",
            "state": "CA",
            "postal_code": "916022371",
            "telephone_number": "818-980-2887",
            "fax_number": "818-980-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10745 RIVERSIDE DRIVE",
            "address_2": "SUITE B",
            "city": "TOLUCA LAKE",
            "state": "CA",
            "postal_code": "916022371",
            "telephone_number": "818-980-2887",
            "fax_number": "818-980-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA",
        "first_name": "ESTEBAN",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-01",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "36135",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "36135",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PROVIDER NUMBER",
            "identifier": "B36135",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Allen Garcia Bordman, FNP-C
• Karen Elise Butler, D.O.
• Natalie Cadwallader, LMFT
• Bernadette Caloza, PHARMACIST
• Margaret Amber Cameneti, FNP

• General Practice Dentistry in Toluca Lake, CA
• Providers in Toluca Lake, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.