ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION NPI 1356541361

NPI Information

  • NPI: 1356541361
  • Provider Name: ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION
  • Classification: Clinic/Center - 261QD0000X
  • Specialization: Dental
  • Entity Type: Organization
  • Doing Business As: COSMETIC IMPLANT GOLD DENTAL CENTER
  • Address: 10745 RIVERSIDE DRIVE
    SUITE B
    TOLUCA LAKE, CA
    ZIP 91602
  • Phone: (818) 980-2887

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NPI Details

ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION is a dental clinic center in Toluca Lake, CA. ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION NPI is 1356541361. The provider is registered as an organization entity type.
The provider Is Doing Business As Cosmetic Implant Gold Dental Center.

The provider's business location address is:

10745 RIVERSIDE DRIVE
SUITE B
TOLUCA LAKE, CA
ZIP 91602
Phone: (818) 980-2887
Fax: (818) 980-2807

The provider's authorized official is Esteban D Bonilla .
The authorized official title is Dentist / Owner and has the following contact phone number (818) 980-2887.

The enumeration date for this NPI number is 7/19/2007 and was last updated on 7/19/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QD0000XClinic/CenterDental36135CALIFORNIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1B36135OTHERCALIFORNIAMEDI-CAL PIN

What is NPI?

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This page was last updated on: 3/30/2025

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