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General NPI Number Information
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NPI Number | 1942432273
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Entity Type | Individual
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Provider Name | JONATHAN BUENJEMIA D.D.S
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Gender | Male
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Dates
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Enumeration Date | 08/20/2009
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Last Update Date | 08/20/2009
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Provider Practice Location Address
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Address Line | 9193 SIERRA AVE SUITE B
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City | FONTANA
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State | CA
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Zip | 92335-4776
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Country | US
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Telephone | 909-355-0485
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Fax |
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Provider Business Mailing Address
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Address Line | 11684 LARGO CT
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City | LOMA LINDA
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State | CA
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Zip | 92354-3973
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Country | US
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Telephone | 909-224-4830
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 58437
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License Number State | CA
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