Karl Omer Boltie, DDS
Individual provider Active NPI Dentist · San Juan, TX
NPI 1407907223 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1407907223
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 17666 (TX)
- Practice address
- 1211 Raul Longoria Rd.
San Juan, TX 78589 - Phone
- (956) 787-4840
- Fax
- (956) 787-4840
- NPI assigned
- Jan 16, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17666 | TX | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 17666 | TX | Yes |
Addresses
Primary practice location
1211 Raul Longoria Rd.
San Juan, TX 78589
Mailing address
4708 N 9TH St
McAllen, TX 78504-2930
Phone (956) 972-1558
Other providers in San Juan, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.