NPIMap

Organization Active NPI

Wildhorse Dental Care, LLC

  • General Practice Dentistry
  • Lake St Louis, MO
National Provider Identifier
1194322990
Registry record updated Jul 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
WILDHORSE DENTAL CARE, LLC
Doing business as
New Creation Dental Care
Practice address
191 Civic Center Dr
Lake St Louis, MO 63367-3027
Phone
(636) 561-6400
NPI assigned
Oct 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2021

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

Authorized official

Name
Dr. Matthew Boscia, DMDNPI 1043540552
Title
President
Phone
(636) 561-6400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

191 Civic Center Dr
Lake St Louis, MO 63367-3027

Mailing address

191 Civic Center Dr
Lake St Louis, MO 63367-3027
Phone (636) 561-6400

Other names 1

  • New Creation Dental Care Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL newcreationdentalcare.com

National Provider Directory

National Provider Directory

Locations

191 Civic Center Dr
Lake St Louis, MO 63367
Phone (636) 561-6400

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1601856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626134400000",
    "number": "1194322990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 CIVIC CENTER DR",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633673027",
            "telephone_number": "636-561-6400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 CIVIC CENTER DR",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633673027",
            "telephone_number": "636-561-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDHORSE DENTAL CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-05",
        "last_updated": "2021-07-13",
        "certification_date": "2021-07-13",
        "status": "A",
        "authorized_official_last_name": "BOSCIA",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "636-561-6400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "newcreationdentalcare.com",
            "affiliation": "N",
            "address_1": "191 Civic Center Dr",
            "city": "Lake St Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "633673027",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "New Creation Dental Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "New Creation Dental Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake St Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2021; 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.