John G. Bozich, D.M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D6611 Issued in OR

Practice address

700 NE Multnomah St
Suite 840
Portland, OR 97232-2131

Phone

(503) 232-4488

Fax

(503) 239-4075

NPI assigned

May 3, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jun 9, 2014 through Jun 9, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1265644306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 NE MULTNOMAH ST",
            "address_2": "SUITE 840",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322131",
            "telephone_number": "503-232-4488",
            "fax_number": "503-239-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 NE MULTNOMAH ST",
            "address_2": "SUITE 840",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972322131",
            "telephone_number": "503-232-4488",
            "fax_number": "503-239-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOZICH",
        "first_name": "JOHN",
        "middle_name": "G.",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OR",
            "license": "D6611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF OREGON DENTAL",
            "identifier": "D6611",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "159012",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaleigh E Boysen-Quinata, MS
• Miranda Boyte
• Tamara Bozaric, PHARMD
• Elizabeth Bozarth
• Karenna Bozicevich, MS, LPC
• BR Electrolysis, LLC
• KC Braaten, MD
• Melissa Brabham, NCC
• Travis Brace, PHD
• Brian Bracelin, LCSW

• Oral and Maxillofacial Surgery (Dentist) in Portland, OR
• Providers in Portland, OR by specialty
• Oral and Maxillofacial Surgery (Dentist) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.