Active NPI
Boley Jacob Greenwood, D.D.S.
- Pediatric Dentistry
- American Fork, UT
National Provider Identifier
1144307992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 30-023398
- Practice address
- 226 N 1100 E
American Fork, UT 84003-2054 - Phone
- (801) 756-6037
- Fax
- (801) 756-6088
- NPI assigned
- Nov 1, 2006
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6215313-9922 | UT | |
| Pediatric Dentistry | 1223P0221X | 30-023398 | OH | Primary |
Addresses
Primary practice location
226 N 1100 E
American Fork, UT 84003-2054
Mailing address
5860 Alexis Rd.
Sylvania, OH 43560
Phone (419) 882-7187
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6215313-9922 | UT | MD | General Practice Dentistry |
| 30-023398 | OH | MD | Pediatric Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sylvania Pediatric Dental Care, Inc. | Pediatric Dentistry | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Pediatric Dentistry
- Sylvania, OH
- NPI 1720004732
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313625600000",
"number": "1144307992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5860 ALEXIS RD.",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "43560",
"telephone_number": "419-882-7187",
"fax_number": "419-882-3165"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "226 N 1100 E",
"city": "AMERICAN FORK",
"state": "UT",
"postal_code": "840032054",
"telephone_number": "801-756-6037",
"fax_number": "801-756-6088"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENWOOD",
"first_name": "BOLEY",
"middle_name": "JACOB",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2011-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "UT",
"license": "6215313-9922",
"primary": false
},
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "OH",
"license": "30-023398",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in American Fork, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.