Jordan Broughton Boone, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7390 Issued in LA

Practice address

140 Veterans Blvd
Denham Springs, LA 70726-5100

Phone

(225) 800-4495

NPI assigned

Dec 5, 2022

Last updated

Jan 5, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Jordan Olivia Broughton Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1670198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704412800000",
    "number": "1548970189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29138 S REDWOOD DR",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707263146",
            "telephone_number": "601-620-9111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "140 VETERANS BLVD",
            "city": "DENHAM SPRINGS",
            "state": "LA",
            "postal_code": "707265100",
            "telephone_number": "225-800-4495"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29138 S Redwood Dr",
            "address_purpose": "LOCATION",
            "city": "Denham Springs",
            "state": "LA",
            "postal_code": "707263146",
            "country_code": "US",
            "telephone_number": "601-620-9111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOONE",
        "first_name": "JORDAN",
        "middle_name": "BROUGHTON",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-12-05",
        "last_updated": "2024-01-05",
        "certification_date": "2023-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "7390",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JORDAN",
            "last_name": "BROUGHTON",
            "middle_name": "OLIVIA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• General Practice Dentistry in Denham Springs, LA
• Providers in Denham Springs, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2024; 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.