MEDICARE: THOMAS BRIAN BOZEMAN DDS

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	1223E0200X	Endodontics	12439	TN
2	1223E0200X	Endodontics	53688	CA

General Provider Information

NPI Number	:	1376638288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS BRIAN BOZEMAN DDS

Provider Business Mailing Address
First Line	:	1820 SONOMA AVE STE 110
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95405-6617
Country	:	US
Telephone Number	:	707-546-2887
Fax Number	:	707-546-2847

Provider Business Practice Location Address
First Line	:	1820 SONOMA AVE
Second Line	:	STE 110
City	:	SANTA ROSA
State	:	CA
Zip	:	95405
Country	:	US
Telephone Number	:	707-546-2887
Fax Number	:	707-546-2847

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	02/11/2026

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