Bonita Springs Edc Management LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BONITA SPRINGS EDC MANAGEMENT LLC

Doing business as

Emergency Dental Care USA

Practice address

8553 W Linebaugh Ave
Tampa, FL 33625-3731

Phone

(813) 926-9228

NPI assigned

Nov 7, 2018

Last updated

Aug 3, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

BONITA SPRINGS EDC MANAGEMENT LLCAs reported in NPPES

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

Authorized official

Name

Michael ObengNPI 1104963172

Title

Manager

Phone

(402) 981-4136

Specialties & licenses 2

Addresses

Other names 1

• Emergency Dental Care USA Doing business as

Tax ID family

Bonita Springs Edc Management LLC2 organizations share this tax ID, including this one

Part of

Bonita Springs Edc Management LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bonita Springs Edc Management LLC

  dba Emergency Dental Care USA

  • Dentist
  • Bonita Springs, FL
  • NPI 1861103731
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Bonita Springs Edc Management LLC

  dba Emergency Dental Care USA

  • Dentist
  • Bonita Springs, FL
  • NPI 1861103731
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael K Obeng, DDS

  • Dentist
  • Omaha, NE
  • NPI 1104963172
  NPD Authorized official

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

{
    "created_epoch": "1541548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1205304375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 788",
            "city": "BOYS TOWN",
            "state": "NE",
            "postal_code": "680100788",
            "telephone_number": "402-658-4687",
            "fax_number": "402-597-3643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8553 W LINEBAUGH AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336253731",
            "telephone_number": "813-926-9228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13247 East Fwy",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770155812",
            "country_code": "US",
            "telephone_number": "832-900-9009",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BONITA SPRINGS EDC MANAGEMENT LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BONITA SPRINGS EDC MANAGEMENT LLC",
        "enumeration_date": "2018-11-07",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "OBENG",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "402-981-4136"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emergency Dental Care USA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Emergency Dental Care USA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jaime Bonilla-Santiago, M.D.
• Nathan James Bonilla-Warford, O.D.
• Christopher Angel Bonilla, MD
• Samantha Bonilla, APRN
• Bonita Cosmetic LLC
• Ebony Nicole Bonner, LMHC
• Edward Bonner
• Gary Bonner, ARNP
• Rita Theresa Bonnett, PHARM.D.
• Zhane Bonnett

• General Practice Dentistry in Tampa, FL
• Providers in Tampa, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2023; 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.