DR. MICHAEL LEE BOBO DDS MD NPI 1417031436

NPI Information

  • NPI: 1417031436
  • Provider Name: DR. MICHAEL LEE BOBO, DDS MD
  • Classification: Dentist - 1223S0112X
  • Specialization: Oral and Maxillofacial Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • CLIA Number: 44D2323262
  • Address: 1109 POPLAR STREET
    MURRAY, KY
    ZIP 42071
  • Phone: (270) 759-4063

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NPI Details

DR. Michael Lee Bobo, DDS MD is an oral and maxillofacial surgery dentist in Murray, KY with 29 years of experience. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. DR. Michael Lee Bobo, DDS MD NPI is 1417031436. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:1997

The provider's business location address is:

1109 POPLAR STREET
MURRAY, KY
ZIP 42071
Phone: (270) 759-4063
Fax: (270) 759-4920

The NPI 1417031436 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The CLIA number assigned to this NPI record is 44D2323262 - physician office with a certificate type of Certificate of Waiver.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • New patient office or other outpatient visit, 30-44 minutes (HCPCS:99203)
  • Established patient office or other outpatient visit, 20-29 minutes (HCPCS:99213)

The enumeration date for this NPI number is 10/25/2006 and was last updated on 7/12/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial Surgery34759KENTUCKYNo
2204E00000XOral & Maxillofacial Surgery34759KENTUCKYNo
31223S0112XDentistOral and Maxillofacial Surgery7465 DENTALKENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11836201MEDICARE PINKENTUCKY
260000163MEDICAIDKENTUCKY
3H59387MEDICARE UPIN
464011711MEDICAIDKENTUCKY

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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