Bouali Frederick Amoli, D.M.D. M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DN 21029 Issued in FL

Practice address

5149 Normandy Blvd Unit 4
Jacksonville, FL 32205-4861

Phone

(904) 781-1201

NPI assigned

Jun 12, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: bamoli37642@direct.shands.ufl.edu

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

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424649600000",
    "number": "1306073754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5149 NORMANDY BLVD UNIT 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322054861",
            "telephone_number": "904-781-1201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5149 NORMANDY BLVD UNIT 4",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322054861",
            "telephone_number": "904-781-1201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMOLI",
        "first_name": "BOUALI",
        "middle_name": "FREDERICK",
        "name_prefix": "Dr.",
        "credential": "D.M.D.  M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-12",
        "last_updated": "2015-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DRP781",
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "FL",
            "license": "ME119684",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN 21029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "012224600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ayanna Ammons
• Christelle Ammons, PA-C
• Alexandria Amodeo, M.A.
• Elizabeth Amoff, DDS
• Amole Care LLC
• Marielle Ameli Amoli, MD
• Melissa Folasade Amoran
• Amore Quality Service
• Amy Amornmarn, MD
• Lulu Amornmarn, M.D., M.P.H.

• Oral and Maxillofacial Surgery (Dentist) in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Oral and Maxillofacial Surgery (Dentist) in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2015; 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.