Samantha Bona

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

108558 Issued in CA

Practice address

90 Middlefield Rd # 1
Menlo Park, CA 94025-4001

Phone

(650) 323-0264

NPI assigned

Aug 24, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Tse Dental Corporation

  dba Chompers Pediatric Dentistry

  • Pediatric Dentistry
  • South San Francisco, CA
  • NPI 1225465560
  NPD (past)
• Shine Az LLC

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

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

{
    "created_epoch": "1440374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685664000000",
    "number": "1255708491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7372 MCKNIGHT RD",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152373558",
            "telephone_number": "412-364-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 MIDDLEFIELD RD # 1",
            "city": "MENLO PARK",
            "state": "CA",
            "postal_code": "940254001",
            "telephone_number": "650-323-0264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1215 Mission Rd",
            "address_purpose": "LOCATION",
            "city": "South San Francisco",
            "state": "CA",
            "postal_code": "940801397",
            "country_code": "US",
            "telephone_number": "650-871-5437",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONA",
        "first_name": "SAMANTHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-24",
        "last_updated": "2023-06-02",
        "certification_date": "2023-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS040572",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "CA",
            "license": "108558",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Michael Blonigen, PH.D.
• Laura Michele Blue, BSN
• Jessica Bocca, LCSW
• David N. Bogart, P.T.
• Jodie L Bogomilsky, M.D.
• Adeline Bortz
• Jeane Bosch, PHD
• Nicholas T Bott, PSY.D.
• Melissa Christina Bourbonniere, OTRL
• Monica Bowditch, L.AC.

• Pediatric Dentistry in Menlo Park, CA
• Providers in Menlo Park, CA by specialty
• Pediatric Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.