Jonar R Bonifacio, DDS
Individual provider Active NPI Dentist · Alpine, CA
NPI 1164436705 · NPPES record last updated Apr 26, 2017
Key facts
- NPI
- 1164436705
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 47454 (CA)
- Practice address
- 1620 Alpine Blvd
#121
Alpine, CA 91901-1102 - Phone
- (619) 445-8896
- Fax
- (619) 445-7339
- NPI assigned
- Jul 28, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160503002582 | CA | Order and Referring Only - Dentist |
0446559041 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 47454 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jonar R Bonifacio, DDS, Inc | Current |
Accepting new patients | |
| Alpine Dentistry | Dentist | Past | Accepting new patients |
Locations
1620 Alpine Blvd
Ste 121
Alpine, CA 91901
Phone (619) 445-8896
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 47454 | CA | Yes |
Addresses
Primary practice location
1620 Alpine Blvd
#121
Alpine, CA 91901-1102
Mailing address
1620 Alpine Blvd
#121
Alpine, CA 91901-1102
Phone (619) 445-8896
Other providers in Alpine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.