Blue Cedar Dentistry LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

BLUE CEDAR DENTISTRY LLC

Practice address

121 N Main Ave
Bolivar, MO 65613-1517

Phone

(702) 283-8421

NPI assigned

Jun 5, 2021

Last updated

Jun 7, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nathan Bowen, DMDNPI 1841638525

Title

Owner

Phone

(702) 283-8421

Specialties & licenses 1

Addresses

Electronic endpoints 1

Locations

Practitioners 1

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.

• Nathan Daniel Bowen, DMD

  • Dentist
  • Battlefield, MO
  • NPI 1841638525
  Authorized official Same address or phone

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

{
    "created_epoch": "1622851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623024000000",
    "number": "1528635919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 N MAIN AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 N MAIN AVE",
            "city": "BOLIVAR",
            "state": "MO",
            "postal_code": "656131517",
            "telephone_number": "702-283-8421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE CEDAR DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-05",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A",
        "authorized_official_last_name": "BOWEN",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-283-8421",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bluecedardentistry@gmail.com",
            "affiliation": "N",
            "address_1": "121 N Main Ave",
            "city": "Bolivar",
            "state": "MO",
            "country_code": "US",
            "postal_code": "656131517",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tara Leanne Billingslea
• Debby Black, PLPC
• Carl L Blomenkamp, D.C.
• Blue Castle Bolivar LLC
• Blue Castle, LLC
• Bolivar Eye Specialty Center
• Bolivar Family Care Center
• Bolivar Family Care Center, LLC
• Bolivar Medical Center, Inc
• Bolivar Medical Center, Inc.

• Dental Clinic/Center in Bolivar, MO
• Providers in Bolivar, MO by specialty
• Dental Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 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.

Verify at the official NPI Registry.