Bernard James Boback III, DMD MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DDS101535 Issued in CA

Practice address

40307 Miklich Dr
Murrieta, CA 92563-4352

Phone

(570) 362-3771

NPI assigned

Jul 25, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1154844702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 WEEPING WILLOW RD",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919151681",
            "telephone_number": "570-362-3771"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40307 MIKLICH DR",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925634352",
            "telephone_number": "570-362-3771"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10974 1/4 Roebling Ave",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900242723",
            "country_code": "US",
            "telephone_number": "570-362-3771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOBACK",
        "first_name": "BERNARD",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DMD MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-25",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TX",
            "license": "34613",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "CA",
            "license": "DDS101535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "DDS101535",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Sabrina Blum, BA, MS (IP)
• Bridget Bo- Lane
• Ferlyn Dale Bobis, PT
• Todd Boehm, PHARMD.
• Timothy Daniel Bohan, CRNA
• Katelyn Bohnisch
• Clarissa Carmen Boitnott

• Orthodontics and Dentofacial Orthopedics Dentistry in Murrieta, CA
• Providers in Murrieta, CA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.