Active NPI
Scott E Bomberg, DDS
- Prosthodontics
- Peoria, AZ
National Provider Identifier
1740246305
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 6169
- Practice address
- 30647 N 129TH Ave
Peoria, AZ 85383-7827 - Phone
- (310) 483-5040
- NPI assigned
- Apr 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 6169 | CO | Primary |
Addresses
Primary practice location
30647 N 129TH Ave
Peoria, AZ 85383-7827
Mailing address
30647 N 129TH Ave
Peoria, AZ 85383-7827
Phone (310) 483-5040
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6169 | CO | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1145836800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1360886400000",
"number": "1740246305",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "30647 N 129TH AVE",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853837827",
"telephone_number": "310-483-5040"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30647 N 129TH AVE",
"city": "PEORIA",
"state": "AZ",
"postal_code": "853837827",
"telephone_number": "310-483-5040"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOMBERG",
"first_name": "SCOTT",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-24",
"last_updated": "2013-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "CO",
"license": "6169",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.