Alexis Bourgeois, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11894 Issued in TN

Practice address

6630 Summer Knoll Cir Ste 103
Bartlett, TN 38134-2926

Phone

(901) 377-5060

NPI assigned

Jun 15, 2022

Sex

Female

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

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.

• Full Throttle Dental, PLLC

  • General Practice Dentistry
  • Bartlett, TN
  • NPI 1336875558
  NPD (past)

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

{
    "created_epoch": "1655251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1063142701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 WESTBRIAR DR",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380165134"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6630 SUMMER KNOLL CIR STE 103",
            "city": "BARTLETT",
            "state": "TN",
            "postal_code": "381342926",
            "telephone_number": "901-377-5060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOURGEOIS",
        "first_name": "ALEXIS",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-15",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TN",
            "license": "11894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Body for Life LLC
• Kayla Bolden
• Sandra J Boldreghini, FNP
• Rachel Bolick, LCSW
• Rene Maria Booth, OTR/L
• Mark None Bowman, L.P.C.
• Ashley Nations Bradford, PT, DPT
• John Paul Bradley, FNP
• Stephen D Brandenburg, D.C.
• Brenda Graceful Living LLC

• General Practice Dentistry in Bartlett, TN
• Providers in Bartlett, TN by specialty
• General Practice Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; 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.