NPIMap

Organization Active NPI

Bouyean Dentistry PLLC

  • General Practice Dentistry
  • Fort Stockton, TX
National Provider Identifier
1558085563
Registry record updated Oct 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
BOUYEAN DENTISTRY PLLC
Practice address
1108 W Dickinson Blvd Ste B
Fort Stockton, TX 79735-4201
Phone
(432) 336-8700
NPI assigned
Oct 3, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2022

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

Authorized official

Name
Dr. Nickolas Kim, DDSNPI 1497233761
Title
Dentist
Phone
(702) 505-1257

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

1108 W Dickinson Blvd Ste B
Fort Stockton, TX 79735-4201

Mailing address

1108 W Dickinson Blvd Ste B
Fort Stockton, TX 79735-4201
Phone (432) 336-8700

National Provider Directory

National Provider Directory

Locations

1108 W Dickinson Blvd
Ste B
Fort Stockton, TX 79735
Phone (432) 336-8574

Practitioners & affiliated clinicians

Practitioners 1

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": "1664755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664755200000",
    "number": "1558085563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1108 W DICKINSON BLVD STE B",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797354201",
            "telephone_number": "432-336-8700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 W DICKINSON BLVD STE B",
            "city": "FORT STOCKTON",
            "state": "TX",
            "postal_code": "797354201",
            "telephone_number": "432-336-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOUYEAN DENTISTRY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-03",
        "last_updated": "2022-10-03",
        "certification_date": "2022-10-03",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "NICKOLAS",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "702-505-1257",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Stockton, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2022; 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.