Culberson Reeves Boren, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

013063 Issued in TX

Practice address

7916 S Broadway Ave Ste 150
Tyler, TX 75703-5287

Phone

(903) 581-2198

Fax

(903) 581-9571

NPI assigned

Oct 19, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Culberson R Boren DDS

  • Pediatric Dentistry
  • Jacksonville, TX
  • NPI 1215208947
  NPD (past) Authorized official
• Culberson R Boren DDS PA

  • Pediatric Dentistry
  • Longview, TX
  • NPI 1215290697
  NPD (past) Authorized official
• Culberson R. Boren, D.D.S., P.a.

  • Pediatric Dentistry
  • Tyler, TX
  • NPI 1033411962
  NPD (past) Authorized official

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1497837587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7916 S BROADWAY AVE STE 150",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035287",
            "telephone_number": "903-581-2198",
            "fax_number": "903-581-9571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7916 S BROADWAY AVE STE 150",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757035287",
            "telephone_number": "903-581-2198",
            "fax_number": "903-581-9571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "705 E Marshall Ave Ste 4002",
            "address_purpose": "LOCATION",
            "city": "Longview",
            "state": "TX",
            "postal_code": "756015660",
            "country_code": "US",
            "telephone_number": "903-993-4376",
            "fax_number": "903-993-0330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1634 S Jackson St",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "TX",
            "postal_code": "757663028",
            "country_code": "US",
            "telephone_number": "903-284-6149",
            "fax_number": "903-284-6156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOREN",
        "first_name": "CULBERSON",
        "middle_name": "REEVES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "013063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008045903",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008045904",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008045902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Guillermo Boonstra
• Kristyn Alexis Booth
• Kent B Boozer, D.D.S.
• McCray Knox Boozer
• Margarete Borck, M.D.
• Sunni S. Boren, M.D.
• Kayla Borges, AU.D.
• David Boring, SLP
• Emily P. Boring, SLP
• Peter Borke, CSFA

• Pediatric Dentistry in Tyler, TX
• Providers in Tyler, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; 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.