Active NPI
Kellen and Ramona Bosma DMD PC
- Dental Clinic/Center
- Sycamore, IL
National Provider Identifier
1932585528
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- License
- 019029540
- Legal business name
- KELLEN AND RAMONA BOSMA DMD PC
- Practice address
- 2600 Dekalb Ave
Suite D
Sycamore, IL 60178-3131 - Phone
- (815) 758-5045
- NPI assigned
- Aug 5, 2015
- Last updated
- Aug 5, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Kellen Bosma, D.M.D.
- Title
- President
- Phone
- (815) 758-5045
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | 019029540 | IL | Primary |
Addresses
Primary practice location
2600 Dekalb Ave
Suite D
Sycamore, IL 60178-3131
Mailing address
2600 Dekalb Ave
Suite D
Sycamore, IL 60178-3131
Phone (815) 758-5045
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043676443 | Other | IL | NPI TYPE I FOR DR. RAMONA BOSMA |
| 1407288830 | Other | IL | NPI TYPE I |
National Provider Directory
National Provider DirectoryLocations
2600 DeKalb Ave
Ste D
Sycamore, IL 60178
Phone (815) 758-5045
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Dentist
- Litchfield, IL
- NPI 1407288830
-
- Dentist
- Creve Coeur, MO
- NPI 1043476443
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1438732800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1438732800000",
"number": "1932585528",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 DEKALB AVE",
"address_2": "SUITE D",
"city": "SYCAMORE",
"state": "IL",
"postal_code": "601783131",
"telephone_number": "815-758-5045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 DEKALB AVE",
"address_2": "SUITE D",
"city": "SYCAMORE",
"state": "IL",
"postal_code": "601783131",
"telephone_number": "815-758-5045"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KELLEN AND RAMONA BOSMA DMD PC",
"organizational_subpart": "NO",
"enumeration_date": "2015-08-05",
"last_updated": "2015-08-05",
"status": "A",
"authorized_official_last_name": "BOSMA",
"authorized_official_first_name": "KELLEN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "815-758-5045",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "D.M.D."
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": "IL",
"license": "019029540",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI TYPE I FOR DR. RAMONA BOSMA",
"identifier": "1043676443",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI TYPE I",
"identifier": "1407288830",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sycamore, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.