John Michael Bozanich, DDS, MS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

103783 Issued in CA

Practice address

2305 Mendocino Ave
Santa Rosa, CA 95403-3157

Phone

(707) 525-1500

Fax

(707) 525-0315

NPI assigned

May 29, 2011

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

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 Apr 22, 2026 through Apr 22, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Legend Dental PLLC

  • Dentist
  • Austin, TX
  • NPI 1003111006
  NPD (past)

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

{
    "created_epoch": "1306627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673481600000",
    "number": "1629362363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1822 SHERWOOD CT",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954054660",
            "telephone_number": "281-731-9403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 MENDOCINO AVE",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954033157",
            "telephone_number": "707-525-1500",
            "fax_number": "707-525-0315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOZANICH",
        "first_name": "JOHN",
        "middle_name": "MICHAEL",
        "credential": "DDS, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-29",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TX",
            "license": "26498",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "103783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn J Boyd, R.D.
• Krista Leanne Boyd, MA, MARRIAGE FAMILY
• Shannon Boyd, PT, DPT
• Michael J. Boyers, MD
• Patricia Jean Boyle, PTA
• Marek Bozdech, M.D.
• Jenna Grace Bozzetto
• Brabetz, Inc.
• Ethan Brabo
• Albert Bracamonte

• Periodontics in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.