Active NPI
David Edwin Bomar, D.D.S.
- General Practice Dentistry
- Tarzana, CA
National Provider Identifier
1982611406
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 21544
- Practice address
- 18399 Ventura Blvd
Suite 230
Tarzana, CA 91356-4233 - Phone
- (818) 881-2315
- Fax
- (818) 344-1361
- NPI assigned
- Aug 1, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 21544 | CA | Primary |
Addresses
Primary practice location
18399 Ventura Blvd
Suite 230
Tarzana, CA 91356-4233
Mailing address
18399 Ventura Blvd
Suite 230
Tarzana, CA 91356-4233
Phone (818) 881-2315
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 |
|---|---|---|---|---|
| I20150622001521 | CA | Order and Referring Only - Dentist | 7012228760 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1982611406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "18399 VENTURA BLVD",
"address_2": "SUITE 230",
"city": "TARZANA",
"state": "CA",
"postal_code": "913564233",
"telephone_number": "818-881-2315",
"fax_number": "818-344-1361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18399 VENTURA BLVD",
"address_2": "SUITE 230",
"city": "TARZANA",
"state": "CA",
"postal_code": "913564233",
"telephone_number": "818-881-2315",
"fax_number": "818-344-1361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOMAR",
"first_name": "DAVID",
"middle_name": "EDWIN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "21544",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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- Julie Sarah Bork
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.