Gregory John Booth, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-4300 Issued in ID

Practice address

9733 W Ustick Rd
Boise, ID 83704-5202

Phone

(208) 375-8720

Fax

(208) 375-8734

NPI assigned

Jul 28, 2010

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

Medicare fee-for-service enrollment

Enrolled in ID

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

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.

• Ustick Dental Office

  • General Practice Dentistry
  • Boise, ID
  • NPI 1740454388
  NPD (past)

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

{
    "created_epoch": "1280275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280275200000",
    "number": "1073827333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "572 E KAIBAB TRAIL DR",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836463777",
            "telephone_number": "208-631-8244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9733 W USTICK RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837045202",
            "telephone_number": "208-375-8720",
            "fax_number": "208-375-8734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "GREGORY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-28",
        "last_updated": "2010-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-4300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Boomhower
• Booth Psychological Solutions, PLLC
• Cathleen Marielle Booth
• Elisha Dawn Booth, LPC
• George C. Booth, MD
• Kristi Lyn Booth, OT
• Matthew Ryan Booth, PT
• Kristin G Booton, MS CCC-SLP
• Lisa Andrea Bootsma, CRNA
• Alexandra Evelyn Bope Miongolo, LCSW

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2010; 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.