NPIMap

Organization Active NPI

Kent B Boozer DDS PA

  • Pediatric Dentistry
  • Tyler, TX
National Provider Identifier
1508046129
Registry record updated Nov 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
20107 Issued in TX
Legal business name
KENT B BOOZER DDS PA
Practice address
5540 Old Jacksonville Hwy
Tyler, TX 75703-3378
Phone
(903) 597-2121
Fax
(903) 581-7776
NPI assigned
Nov 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2007

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

Authorized official

Name
Dr. Kent B Boozer, DDSNPI 1578502878
Title
Dentist/Owner
Phone
(903) 597-2121

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
Pediatric DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223P0221X 20107 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

Other names 1

  • Boozer Dental Works Doing business as

National Provider Directory

National Provider Directory

Locations

5540 Old Jacksonville Hwy
Tyler, TX 75703
Phone (903) 597-2121

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1194825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194825600000",
    "number": "1508046129",
    "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",
            "fax_number": "903-581-7776"
        },
        {
            "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",
            "fax_number": "903-581-7776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT B BOOZER DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-12",
        "last_updated": "2007-11-12",
        "status": "A",
        "authorized_official_last_name": "BOOZER",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "903-597-2121",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "20107",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boozer Dental Works",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Nov 12, 2007; 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.