Boulos Dental Care, P.C.

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

12329 Issued in MN

Legal business name

BOULOS DENTAL CARE, P.C.

Practice address

470 Highway 96 W
Suite 200
Shoreview, MN 55126-1996

Phone

(952) 465-7210

NPI assigned

Apr 7, 2011

Last updated

Apr 7, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Samy Wasfy Yousef Boulos

Title

Dentist (DDS)

Phone

(952) 465-7210

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302134400000",
    "number": "1023308392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 CARLSON PKWY",
            "address_2": "APT #115",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553055334",
            "telephone_number": "952-465-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 HIGHWAY 96 W",
            "address_2": "SUITE 200",
            "city": "SHOREVIEW",
            "state": "MN",
            "postal_code": "551261996",
            "telephone_number": "952-465-7210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULOS DENTAL CARE, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-07",
        "last_updated": "2011-04-07",
        "status": "A",
        "authorized_official_last_name": "BOULOS",
        "authorized_official_first_name": "SAMY",
        "authorized_official_middle_name": "WASFY YOUSEF",
        "authorized_official_title_or_position": "DENTIST (DDS)",
        "authorized_official_telephone_number": "952-465-7210",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "MN",
            "license": "12329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Fisher Blackford, PT
• Justin Kyle Blood, PT, DPT, OCS
• Courtney Boland
• Jeffrey Bonsell, DC
• Percy Botchway, ATC
• Mina Samy Boulos, DDS
• Samy Wasfy Boulos, DDS
• Lauren Brodzinski
• Daniel J Brown, DC
• Jill Marie Buckingham, DTR, LICSW

• Exclusive Provider Organization in Shoreview, MN
• Providers in Shoreview, MN by specialty
• Exclusive Provider Organization in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2011; 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.