Byron Austin Bonebreak Jr., D.M.D. M.S.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

6368 Issued in MD

Practice address

8191 Maple Lawn Blvd Ste E
Fulton, MD 20759-2535

Phone

(410) 381-1077

NPI assigned

Feb 3, 2011

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Vanguard Orthodontics LLC

  • Dental Clinic/Center
  • Fulton, MD
  • NPI 1629583943
  NPD (past)

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

{
    "created_epoch": "1296691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1942506282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12240 PLEASANT SPRINGS CT",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207599647",
            "telephone_number": "410-381-1077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8191 MAPLE LAWN BLVD STE E",
            "city": "FULTON",
            "state": "MD",
            "postal_code": "207592535",
            "telephone_number": "410-381-1077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8640 Guilford Rd",
            "address_2": "Suite 233",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MD",
            "postal_code": "210462655",
            "country_code": "US",
            "telephone_number": "410-381-1077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12230 Clarksville Pike",
            "address_2": "Suite M",
            "address_purpose": "LOCATION",
            "city": "Clarksville",
            "state": "MD",
            "postal_code": "21029",
            "country_code": "US",
            "telephone_number": "410-381-1077",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8640 Guilford Rd",
            "address_2": "Suite 233",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "MD",
            "postal_code": "210462655",
            "country_code": "US",
            "telephone_number": "410-381-1077",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BONEBREAK",
        "first_name": "BYRON",
        "middle_name": "AUSTIN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D. M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-02-03",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "MD",
            "license": "6368",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Fulton, MD
• Providers in Fulton, MD by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.