MEDICARE: BO RAM UM DDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1306799788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BO RAM UM DDS, INC.

Provider Business Mailing Address
First Line	:	11481 HEACOCK ST STE 160
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-7906
Country	:	US
Telephone Number	:	951-242-5470
Fax Number	:

Provider Business Practice Location Address
First Line	:	11481 HEACOCK ST STE 160
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92557-7906
Country	:	US
Telephone Number	:	951-242-5470
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BO RAM UM
Credential	:	DDS
Telephone Number	:	951-242-5470

Provider Enumeration Date	:	02/17/2026
Last Update Date	:	02/17/2026

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