Paul Gregory Boerman, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

0160000990 Issued in VT

Practice address

44 Timber Lane
South Burlington, VT 05403-7282

Phone

(802) 860-6725

Fax

(802) 864-1511

NPI assigned

Jul 28, 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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Oct 1, 2024 through Oct 1, 2026

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104830512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44 TIMBER LANE",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037282",
            "telephone_number": "802-860-6725",
            "fax_number": "802-864-1511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44 TIMBER LANE",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037282",
            "telephone_number": "802-860-6725",
            "fax_number": "802-864-1511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOERMAN",
        "first_name": "PAUL",
        "middle_name": "GREGORY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "VT",
            "license": "0160000990",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9446",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP",
            "identifier": "102V101",
            "state": "VT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8309",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Joseph Blasius, DMD MDS MPH
• Bloom Physical Therapy LLC
• Jonathan A Bloom, D.D.S.
• Victor Boardman
• Body Resolution LLC
• Brittany Bogan, DOCTOR OF PHARMACY
• Shawn Bohac
• Allyson M Bolduc, M.D.
• Wendy Pinder Bombard
• Laura Anne Bonazinga, M.S., SLP-CCC

• Oral and Maxillofacial Surgery (Dentist) in South Burlington, VT
• Providers in South Burlington, VT by specialty
• Oral and Maxillofacial Surgery (Dentist) in Vermont

• 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.