Amy Johanna Bouvier Poblenz, D.M.D., M.S.
Individual provider Active NPI Orthodontics and Dentofacial Orthopedics Dentistry · Atlantic Beach, FL
NPI 1447591789 · NPPES record last updated Feb 6, 2018
Key facts
- NPI
- 1447591789
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry 1223X0400X
- License
- DN18750 (FL)
- Practice address
- 1023 Atlantic Blvd
Atlantic Beach, FL 32233-3313 - Phone
- (904) 249-3104
- Fax
- (904) 249-3109
- NPI assigned
- Mar 12, 2013
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9611 | TN | MD | Clinical Social Worker |
| 62078 | CA | MD | Dentist |
| DN18750 | FL | MD | Orthodontics and Dentofacial Orthopedic Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 62078 | CA | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 9611 | TN | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | DN18750 | FL | Yes |
Addresses
Primary practice location
1023 Atlantic Blvd
Atlantic Beach, FL 32233-3313
Mailing address
1023 Atlantic Blvd
Atlantic Beach, FL 32233-3313
Phone (904) 249-3104
Other providers in Atlantic Beach, FL
- Ashton Berry
- Brian Blaustein
- Bloom Behavioral Solutions
- Bloom Behavioral Solutions, Inc.
- Lisabeth Boudreaux
- Meghan Braun
- Eric T. Broe
- Meredith Nancy Broner
- Charlene Bryson
- Elena Burch
All providers in Atlantic Beach, FL · Orthodontics and Dentofacial Orthopedics Dentistry in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2018. 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.