NPIMap

Organization Active NPI

Esteban D. Bonilla DDS Professional Corporation

  • Dental Clinic/Center
  • Toluca Lake, CA
National Provider Identifier
1356541361
Registry record updated Jul 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
36135 Issued in CA
Legal business name
ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION
Doing business as
Cosmetic Implant Gold Dental Center
Practice address
10745 Riverside Drive
Suite B
Toluca Lake, CA 91602
Phone
(818) 980-2887
Fax
(818) 980-2807
NPI assigned
Jul 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2007

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

Authorized official

Name
Dr. Esteban D Bonilla, D.D.S.NPI 1114148723
Title
Dentist / Owner
Phone
(818) 980-2887

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 36135 CA Primary

Addresses

Primary practice location

10745 Riverside Drive
Suite B
Toluca Lake, CA 91602

Mailing address

10745 Riverside Drive
Suite B
Toluca Lake, CA 91602
Phone (818) 980-2887

Other identifiers 1

IdentifierTypeStateIssuer
B36135OtherCAMEDI-CAL PIN

Other names 1

  • Cosmetic Implant Gold Dental Center Doing business as

National Provider Directory

National Provider Directory

Locations

10745 Riverside Dr
Ste B
Toluca Lake, CA 91602
Phone (818) 769-5626

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1184803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184803200000",
    "number": "1356541361",
    "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": "91602",
            "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": "91602",
            "telephone_number": "818-980-2887",
            "fax_number": "818-980-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-19",
        "last_updated": "2007-07-19",
        "status": "A",
        "authorized_official_last_name": "BONILLA",
        "authorized_official_first_name": "ESTEBAN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DENTIST / OWNER",
        "authorized_official_telephone_number": "818-980-2887",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "36135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDI-CAL PIN",
            "identifier": "B36135",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cosmetic Implant Gold Dental Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Toluca Lake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 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.