Gregory Bouldien, DDS MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

5213 Issued in TN

Practice address

9880 Goodman Rd
Olive Branch, MS 38654-1722

Phone

(662) 470-4919

Fax

(662) 874-6295

NPI assigned

Aug 22, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dormois & Fuson, P.L.L.C.

  • Pediatric Dentistry
  • Southaven, MS
  • NPI 1639235963
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1013023837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9880 GOODMAN RD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541722",
            "telephone_number": "662-470-4919",
            "fax_number": "662-874-6295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9880 GOODMAN RD",
            "city": "OLIVE BRANCH",
            "state": "MS",
            "postal_code": "386541722",
            "telephone_number": "662-470-4919",
            "fax_number": "662-874-6295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7734 Airways Blvd",
            "address_purpose": "LOCATION",
            "city": "Southaven",
            "state": "MS",
            "postal_code": "386715306",
            "country_code": "US",
            "telephone_number": "662-349-3838",
            "fax_number": "662-349-5923",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7675 Wolf River Cir Ste 102",
            "address_purpose": "LOCATION",
            "city": "Germantown",
            "state": "TN",
            "postal_code": "381381747",
            "country_code": "US",
            "telephone_number": "901-363-8191",
            "fax_number": "662-363-2774",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOULDIEN",
        "first_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "DDS MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TN",
            "license": "5213",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BMB Medical Beautique
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• Jennifer Dixon Bogan, PT
• Margo Denice Boler, O. D.
• Tessica C. Boney, LCSW
• Shandra Bouzemann
• Sondra Bowen
• Traci D Bowen
• Taylor Breanne Bowers, CF-SLP
• Jordan Boyd

• Orthodontics and Dentofacial Orthopedics Dentistry in Olive Branch, MS
• Providers in Olive Branch, MS by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.