| Organization Name: | ESTEBAN D. BONILLA DDS PROFESSIONAL CORPORATION |
| NPI Number: | 1356541361 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ESTEBAN D BONILLA (DENTIST / OWNER) |
| Mailing Address: | 10745 Riverside Drive Suite B Toluca Lake |
| State: | CA US |
| Postal Code: | 91602 |
| Phone Number: | 8189802887 |
| Fax Number: | 8189802807 |
| NPI Enumeration Date: | 07/19/2007 |
| NPI Last Update Date: | 07/19/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 36135 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |