Active NPI
Bethany Ann Flanders, D.D.S.
- General Practice Dentistry
- Tyler, TX
National Provider Identifier
1447703053
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 31989
- Practice address
- 5540 Old Jacksonville Hwy
Tyler, TX 75703-3378 - Phone
- (903) 597-2121
- NPI assigned
- Jul 31, 2016
- Last updated
- May 25, 2021
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 31989 | TX | Primary |
Addresses
Primary practice location
5540 Old Jacksonville Hwy
Tyler, TX 75703-3378
Mailing address
5540 Old Jacksonville Hwy
Tyler, TX 75703-3378
Phone (903) 597-2121
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 |
|---|---|---|---|
| 31989 | TX | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kent B Boozer DDS PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1469923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621900800000",
"number": "1447703053",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5540 OLD JACKSONVILLE HWY",
"city": "TYLER",
"state": "TX",
"postal_code": "757033378",
"telephone_number": "903-597-2121"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5540 OLD JACKSONVILLE HWY",
"city": "TYLER",
"state": "TX",
"postal_code": "757033378",
"telephone_number": "903-597-2121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FLANDERS",
"first_name": "BETHANY",
"middle_name": "ANN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-07-31",
"last_updated": "2021-05-25",
"certification_date": "2021-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "31989",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.