Boca Dental Premier

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BOCA DENTAL PREMIER

Practice address

2018 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6402

Phone

(702) 703-1590

NPI assigned

Aug 11, 2025

Last updated

Sep 5, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mary Wilcox

Title

Director of Billing

Phone

(702) 703-1590

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1754870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757030400000",
    "number": "1306721931",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8989 W FLAMINGO RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891470431",
            "telephone_number": "702-703-1590"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2018 LAKE TAHOE BLVD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506402",
            "telephone_number": "702-703-1590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOCA DENTAL PREMIER",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-08-11",
        "last_updated": "2025-09-05",
        "certification_date": "2025-09-05",
        "status": "A",
        "authorized_official_last_name": "WILCOX",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "DIRECTOR OF BILLING",
        "authorized_official_telephone_number": "702-703-1590"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gregory Walter Bergner, MD
• Sarah Berlin
• Linda Hardin Bingham, MSW
• Marta Biniewicz McLean, LMFT
• Cascade Bishop
• Kbongard Bongard, LICENS. SCH. COUNSEL
• Andrew S Borah, ATC
• Borges Chiropractic a PC
• Caylea Borges
• David Borges, DC

• Dental Clinic/Center in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2025; 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.