Active NPI
Juan Carlos Bosque Sr., DDS
- Endodontics
- San Diego, CA
National Provider Identifier
1750506754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 42723
- Practice address
- 3760 Convoy St
Suite 330
San Diego, CA 92111-3742 - Phone
- (858) 999-5968
- NPI assigned
- Apr 16, 2007
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 42723 | CA | Primary |
Addresses
Primary practice location
3760 Convoy St
Suite 330
San Diego, CA 92111-3742
Mailing address
5514 Bloch St
San Diego, CA 92122-4012
Phone (858) 999-5968
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160610000802 | CA | Order and Referring Only - Other (Physician) | 7214227818 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 42723 | CA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Juan C. Bosque, D.D.S., Inc. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- San Diego, CA
- NPI 1427329952
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176681600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326067200000",
"number": "1750506754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5514 BLOCH ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921224012",
"telephone_number": "858-999-5968"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3760 CONVOY ST",
"address_2": "SUITE 330",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921113742",
"telephone_number": "858-999-5968"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSQUE",
"first_name": "JUAN",
"middle_name": "CARLOS",
"name_prefix": "Dr.",
"name_suffix": "Sr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-16",
"last_updated": "2012-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "42723",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2012; 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.