Michael Joseph Boule, DOCTOR OF DENTAL SUR

Primary specialty

DentistTaxonomy code 122300000X

License

48160 Issued in NY

Practice address

134 Brinkerhoff Street
Plattsburgh, NY 12901

Phone

(518) 563-3090

Fax

(518) 563-5455

NPI assigned

Dec 5, 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1043378722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 JABEZ ALLEN ROAD",
            "city": "PERU",
            "state": "NY",
            "postal_code": "12972",
            "telephone_number": "518-643-0224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 BRINKERHOFF STREET",
            "city": "PLATTSBURGH",
            "state": "NY",
            "postal_code": "12901",
            "telephone_number": "518-563-3090",
            "fax_number": "518-563-5455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULE",
        "first_name": "MICHAEL",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "credential": "DOCTOR OF DENTAL SUR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "48160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02568803",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mandi Moore Bordeau, SET
• Nicole Bordeau
• Branden Boston
• Karen M Bouchard, PT, NCS
• Josee Boulanger, PT
• Boule/Spear Family Dentistry
• Cindy Lou Bourgeois, PHYSICAL THERAPIST A
• Danielle M Bouvier, M.S., NCC, LMHC
• Joshua Bowen, R.PH.
• Eric Scott Boyle

• Dentist in Plattsburgh, NY
• Providers in Plattsburgh, NY by specialty
• Dentist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.