Active NPI
Jack Bourklian, DDS
- Dentist
- Victorville, CA
National Provider Identifier
1801136494
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 62218
- Practice address
- 15290 Bear Valley Rd
#B
Victorville, CA 92395-8515 - Phone
- (760) 951-7777
- NPI assigned
- Feb 19, 2013
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 62218 | CA | Primary |
Addresses
Primary practice location
15290 Bear Valley Rd
#B
Victorville, CA 92395-8515
Mailing address
301 N San Dimas Canyon Rd
101
San Dimas, CA 91773-2741
Phone (909) 599-2023
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 |
|---|---|---|---|
| 62218 | CA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Dental Services, Inc. | Past | Accepting new patients |
Interoperability endpoints
- jbourklian@direct.westerndental.com
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.
-
- General Practice Dentistry
- Victorville, CA
- NPI 1093868390
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1361232000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362960000000",
"number": "1801136494",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 N SAN DIMAS CANYON RD",
"address_2": "101",
"city": "SAN DIMAS",
"state": "CA",
"postal_code": "917732741",
"telephone_number": "909-599-2023"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15290 BEAR VALLEY RD",
"address_2": "#B",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923958515",
"telephone_number": "760-951-7777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURKLIAN",
"first_name": "JACK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-02-19",
"last_updated": "2013-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "62218",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.