Jonathan Bolesta, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

7387 Issued in AZ

Practice address

5940 W Union Hills Dr
B190
Glendale, AZ 85308-1308

Phone

(623) 455-5717

NPI assigned

Aug 29, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shine Az LLC

  • Dental Clinic/Center
  • Glendale, AZ
  • NPI 1689973679
  NPD (past) Authorized official

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

{
    "created_epoch": "1188345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298246400000",
    "number": "1164616405",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5940 W UNION HILLS DR",
            "address_2": "B190",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081308",
            "telephone_number": "623-455-5717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5940 W UNION HILLS DR",
            "address_2": "B190",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853081308",
            "telephone_number": "623-455-5717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLESTA",
        "first_name": "JONATHAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-29",
        "last_updated": "2011-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AZ",
            "license": "7387",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Boe (Native Empowerment)
• Shani Deon Boeh, AAS
• Robert Bofman
• Anne Bojorquez, M.D.
• Librada Bojorquez
• Jenna Bolger, FNP
• Patricia Bolivar, LMSW
• Samantha Anne Bollschweiler
• Mary Ann Bolyog, FNP-C
• Bradley Boman, DO

• Orthodontics and Dentofacial Orthopedics Dentistry in Glendale, AZ
• Providers in Glendale, AZ by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.