Carolyn Deolinda Bullock, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D07836 Issued in AZ

Practice address

320 5TH St
Frederick, CO 80530

Phone

(303) 833-3230

Fax

(303) 833-4477

NPI assigned

Jan 10, 2011

Last updated

Nov 16, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Carolyn Deolinda Boettger Former name

Medicare fee-for-service enrollment

Enrolled in CO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1294617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542326400000",
    "number": "1558665273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 69",
            "city": "FREDERICK",
            "state": "CO",
            "postal_code": "80530",
            "telephone_number": "303-833-3230",
            "fax_number": "303-833-4477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 5TH ST",
            "city": "FREDERICK",
            "state": "CO",
            "postal_code": "80530",
            "telephone_number": "303-833-3230",
            "fax_number": "303-833-4477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "CAROLYN",
        "middle_name": "DEOLINDA",
        "name_prefix": "Mrs.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-10",
        "last_updated": "2018-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D07836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CAROLYN",
            "last_name": "BOETTGER",
            "middle_name": "DEOLINDA",
            "prefix": "MS.",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Derrick Shilo Betting, LPCC
• Abby Elizabeth Bohall, CCC-SLP
• Matthew Brady, D.D.S.
• Randy Phillip Breunig, LPC
• Riley Nicole Buis, COTA/L
• Laura Michele Camp, MSN, NP
• Lindsay Campbell
• Carbon Valley Chiropractic
• Carbon Valley Eye Care
• Patricia Ann Carlson, MA, LPC

• General Practice Dentistry in Frederick, CO
• Providers in Frederick, CO by specialty
• General Practice Dentistry in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.