Shelli Boucher, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11538 Issued in NC

Practice address

185 Marron Dr
Indian Trail, NC 28079-4510

Phone

(860) 428-7204

NPI assigned

Aug 8, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1375920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720483200000",
    "number": "1356773691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "185 MARRON DR",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280794510",
            "telephone_number": "860-428-7204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 MARRON DR",
            "city": "INDIAN TRAIL",
            "state": "NC",
            "postal_code": "280794510",
            "telephone_number": "860-428-7204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUCHER",
        "first_name": "SHELLI",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-08-08",
        "last_updated": "2024-07-09",
        "certification_date": "2024-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "11538",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0442000192",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "8871",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristine Bingerman, LCSWA
• Bini Transportation LLC
• Bio-Medical Applications of North Carolina, Inc. (Fresenius Kidney Care Indian Trail)
• Stephen Joseph Blaha, MD
• Kayler Kershelle Blakeney, MT
• Robbin Artavia Boulware
• Decora Lachelle Bowers, EDD, LCMHC
• Jonathan Austin Bowman, DMD
• Kristina Quick Braun, PT
• Graham Breitenstein

• General Practice Dentistry in Indian Trail, NC
• Providers in Indian Trail, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; 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.