Mina Choe Boudreau, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN1857119 Issued in MA

Practice address

144 Main St
Watertown, MA 02472-4409

Phone

(617) 396-4621

NPI assigned

Mar 14, 2016

Last updated

Feb 23, 2023By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Good Night Sleep Solutions LLC

  • Customized Equipment (DME)
  • Watertown, MA
  • NPI 1184346256
  NPD Authorized official
• Sham Tang and Tam PC

  dba Smilage Dental Center

  • Clinic/Center
  • Framingham, MA
  • NPI 1942354394
  NPD (past)

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

{
    "created_epoch": "1457913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677110400000",
    "number": "1619338084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "144 MAIN ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 MAIN ST",
            "city": "WATERTOWN",
            "state": "MA",
            "postal_code": "024724409",
            "telephone_number": "617-396-4621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "MINA",
        "middle_name": "CHOE",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-03-14",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "DN1857119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Genevieve Bonin, DMD
• Boston ABA
• Boston ABA Corporation
• Boston Child & Adolescent Assessment LLC
• Suzanne M Boucher, M.ED. LMHC
• Erika Bourne, R.N., C.M.T.P.T.
• Catherine Boutin, MSN, RN
• Katherine Bowsza
• Eileen D. Boynton
• Nancy T. Bradley

• General Practice Dentistry in Watertown, MA
• Providers in Watertown, MA by specialty
• General Practice Dentistry in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; 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.