Active NPI
Matthew James Boscia, D.M.D
- General Practice Dentistry
- Lake St Louis, MO
National Provider Identifier
1043540552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2003013106
- Practice address
- 15 Lakeside Dr
Lake St Louis, MO 63367-1378 - Phone
- (636) 625-1225
- Fax
- (636) 625-1228
- NPI assigned
- Jan 5, 2010
- Last updated
- Dec 4, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | 2003013106 | MO | |
| General Practice Dentistry | 1223G0001X | 2003013106 | MO | Primary |
Addresses
Primary practice location
15 Lakeside Dr
Lake St Louis, MO 63367-1378
Mailing address
15 Lakeside Dr Ste a
Lake St Louis, MO 63367-1378
Phone (636) 625-1225
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2003013106 | MO | MD | Durable Medical Equipment & Medical Supplies |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wildhorse Dental Care, LLC | General Practice | Current | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba New Creation Dental Care
- General Practice Dentistry
- Lake St Louis, MO
- NPI 1194322990
-
- General Practice Dentistry
- Lake St Louis, MO
- NPI 1972963460
-
- General Practice Dentistry
- Lake St Louis, MO
- NPI 1801010467
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1262649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1543881600000",
"number": "1043540552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 LAKESIDE DR STE A",
"city": "LAKE ST LOUIS",
"state": "MO",
"postal_code": "633671378",
"telephone_number": "636-625-1225",
"fax_number": "636-625-1228"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 LAKESIDE DR",
"city": "LAKE ST LOUIS",
"state": "MO",
"postal_code": "633671378",
"telephone_number": "636-625-1225",
"fax_number": "636-625-1228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOSCIA",
"first_name": "MATTHEW",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-01-05",
"last_updated": "2018-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "332B00000X",
"taxonomy_group": "",
"desc": "Durable Medical Equipment & Medical Supplies",
"state": "MO",
"license": "2003013106",
"primary": false
},
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2003013106",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake St Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.