Robert C. Bosack, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

Practice address

16011 108TH Ave
Orland Park, IL 60467-8786

Phone

(708) 460-9100

Fax

(708) 460-7919

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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 25, 2018 through Jun 25, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200960000000",
    "number": "1376550558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16011 108TH AVE",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604678786",
            "telephone_number": "708-460-9100",
            "fax_number": "708-460-7919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16011 108TH AVE",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604678786",
            "telephone_number": "708-460-9100",
            "fax_number": "708-460-7919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSACK",
        "first_name": "ROBERT",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy L Bonnevier, LCPC
• Bridget Borrelli, BCBA
• Bosack Dental LLC
• Linda Brigit Bosack, AUD
• Rebecca Bosack, D.D.S.
• Cheryl Ann Boss, ANP-CNP
• Botti Sports & Spine
• Bryan C Bouchelion, DDS
• Firdaus Boufath
• Bounce Back Chiropractic, Inc.

• Oral and Maxillofacial Surgery (Dentist) in Orland Park, IL
• Providers in Orland Park, IL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2008; 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.