Provider Demographics
NPI:1942432273
Name:BUENJEMIA, JONATHAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:BUENJEMIA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11684 LARGO CT
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3973
Mailing Address - Country:US
Mailing Address - Phone:909-224-4830
Mailing Address - Fax:
Practice Address - Street 1:9193 SIERRA AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-4776
Practice Address - Country:US
Practice Address - Phone:909-355-0485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA584371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry