Active NPI
Andrea Lynn Boucher, D.M.D.
- Pediatric Dentistry
- Cape Coral, FL
National Provider Identifier
1497067094
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Dentistry
- License
- DN19099
- Practice address
- 1715 Cape Coral Pkwy W
Cape Coral, FL 33914-6914 - Phone
- (239) 214-2470
- Fax
- (239) 540-3883
- NPI assigned
- Jul 12, 2010
- 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 |
|---|---|---|---|---|
| Pediatric Dentistry | 1223P0221X | DN19099 | FL | Primary |
Addresses
Primary practice location
1715 Cape Coral Pkwy W
Cape Coral, FL 33914-6914
Mailing address
1715 Cape Coral Pkwy W
Cape Coral, FL 33914-6914
Phone (239) 214-2470
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 |
|---|---|---|---|
| DN19099 | FL | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1278892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1372982400000",
"number": "1497067094",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1715 CAPE CORAL PKWY W",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339146914",
"telephone_number": "239-214-2470",
"fax_number": "239-540-3883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1715 CAPE CORAL PKWY W",
"city": "CAPE CORAL",
"state": "FL",
"postal_code": "339146914",
"telephone_number": "239-214-2470",
"fax_number": "239-540-3883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUCHER",
"first_name": "ANDREA",
"middle_name": "LYNN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-07-12",
"last_updated": "2013-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0221X",
"taxonomy_group": "",
"desc": "Dentist, Pediatric Dentistry",
"state": "FL",
"license": "DN19099",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cape Coral, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.