NPIMap

Organization Active NPI

Terry L Boelter DDS PC

  • General Practice Dentistry
  • Sanborn, IA
National Provider Identifier
1467582023
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
6554 Issued in IA
Legal business name
TERRY L BOELTER DDS PC
Practice address
410 N Western St
Sanborn, IA 51248-1109
Phone
(712) 930-5550
Fax
(712) 930-5575
NPI assigned
Mar 6, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terry L Boelter, D.D.S.NPI 1568538775
Title
Owner
Phone
(712) 930-5550

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 6554 IA Primary

Addresses

Primary practice location

410 N Western St
Sanborn, IA 51248-1109

Mailing address

410 N Western St
Sanborn, IA 51248-1109
Phone (712) 930-5550

Other identifiers 1

IdentifierTypeStateIssuer
1004648MedicaidIA

National Provider Directory

National Provider Directory

Locations

410 N Western St
Sanborn, IA 51248
Phone (712) 930-5550

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1467582023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N WESTERN ST",
            "city": "SANBORN",
            "state": "IA",
            "postal_code": "512481109",
            "telephone_number": "712-930-5550",
            "fax_number": "712-930-5575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 N WESTERN ST",
            "city": "SANBORN",
            "state": "IA",
            "postal_code": "512481109",
            "telephone_number": "712-930-5550",
            "fax_number": "712-930-5575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERRY L BOELTER DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BOELTER",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-930-5550",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "6554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1004648",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sanborn, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.