Active NPI
Keith A. Boenning, D.D.S., LLC
- Prosthodontics
- Towson, MD
National Provider Identifier
1376678482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 8257
- Practice address
- 1104 Kenilworth Dr
Suite 104
Towson, MD 21204-2101 - Phone
- (410) 828-1717
- Fax
- (410) 821-0912
- NPI assigned
- Feb 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 8257 | MD | Primary |
Addresses
Primary practice location
1104 Kenilworth Dr
Suite 104
Towson, MD 21204-2101
Mailing address
1104 Kenilworth Dr
Suite 104
Towson, MD 21204-2101
Phone (410) 828-1717
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26-2579369 | Other | MD | FEDERAL TAX ID |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8257 | MD | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172102400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214870400000",
"number": "1376678482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1104 KENILWORTH DR",
"address_2": "SUITE 104",
"city": "TOWSON",
"state": "MD",
"postal_code": "212042101",
"telephone_number": "410-828-1717",
"fax_number": "410-821-0912"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 KENILWORTH DR",
"address_2": "SUITE 104",
"city": "TOWSON",
"state": "MD",
"postal_code": "212042101",
"telephone_number": "410-828-1717",
"fax_number": "410-821-0912"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOENNING",
"first_name": "KEITH",
"middle_name": "A.",
"name_prefix": "Dr.",
"credential": "D.D.S., LLC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-22",
"last_updated": "2008-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "MD",
"license": "8257",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "26-2579369",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Towson, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.