Joseph Robert Boulter, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10715 Issued in FL

Practice address

8823 Goodbys Executive Dr
Jacksonville, FL 32217

Phone

(904) 731-0432

Fax

(904) 731-5755

NPI assigned

Jan 25, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 21, 2015 through Apr 21, 2027

Medicare enrollment (NPD)

Enrolled

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.

• Joseph R. Boulter, D.M.D., M.a.G.D., P.a.

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1225232176
  NPD (past) Authorized official
• Patriot Family Dental PA

  • General Practice Dentistry
  • Jacksonville, FL
  • NPI 1982571584
  NPD (past)

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

{
    "created_epoch": "1138147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1053381632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 GOODBYS EXECUTIVE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32217",
            "telephone_number": "904-731-0432",
            "fax_number": "904-731-5755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8823 GOODBYS EXECUTIVE DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32217",
            "telephone_number": "904-731-0432",
            "fax_number": "904-731-5755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULTER",
        "first_name": "JOSEPH",
        "middle_name": "ROBERT",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-25",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "10715",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "5542",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alan J Boudreau, D.C.
• Laura Boudreaux, ARNP
• Jacquelyn Bouffard
• John George Fletcher Boughey, MBCHB
• Laquitta S Bouknight-Rivers
• Bouncing Beans Pediatric Therapy, LLC
• Ernest Bouras, MD
• Michael Bourassa, D.P.T.
• Amanda J. Bourgeois, OD
• Dorothy Eleanor Bourgeois, CCC-SLP

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.