Healthcare Provider Details

I. General information

NPI: 1376638288
Provider Name (Legal Business Name): THOMAS BRIAN BOZEMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 TROTWOOD AVE STE 2
COLUMBIA TN
38401-4750
US

IV. Provider business mailing address

1324 TROTWOOD AVE STE 2
COLUMBIA TN
38401-4750
US

V. Phone/Fax

Practice location:
  • Phone: 931-388-5627
  • Fax: 931-381-6797
Mailing address:
  • Phone: 931-388-5627
  • Fax: 931-381-6797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number12439
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number53688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: