Active NPI
Marierose Malek Boulos, DDS
- Pediatric Dentistry
- Greensboro, NC
National Provider Identifier
1366699738
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- 7358
- Practice address
- 871 Huffman St
Greensboro, NC 27405-7205 - Phone
- (336) 230-0346
- Fax
- (336) 230-0348
- NPI assigned
- Aug 27, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | 7358 | NC | Primary |
Addresses
Primary practice location
871 Huffman St
Greensboro, NC 27405-7205
Mailing address
871 Huffman St
Greensboro, NC 27405-7205
Phone (336) 230-0346
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1219795200000",
"number": "1366699738",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "871 HUFFMAN ST",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274057205",
"telephone_number": "336-230-0346",
"fax_number": "336-230-0348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "871 HUFFMAN ST",
"city": "GREENSBORO",
"state": "NC",
"postal_code": "274057205",
"telephone_number": "336-230-0346",
"fax_number": "336-230-0348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULOS",
"first_name": "MARIEROSE",
"middle_name": "MALEK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-08-27",
"last_updated": "2008-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "NC",
"license": "7358",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greensboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.