NPIMap

Organization Active NPI

Boulevard Dental Associates

  • General Practice Dentistry
  • Reading, PA
National Provider Identifier
1659509404
Registry record updated Jul 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DS036510 Issued in PA
Legal business name
BOULEVARD DENTAL ASSOCIATES
Practice address
430 Kenhorst Blvd
Reading, PA 19611-1830
Phone
(610) 775-0321
Fax
(610) 777-8884
NPI assigned
Jun 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2009

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

Authorized official

Name
Dr. Timothy Medianick, DMD
Title
Owner
Phone
(610) 775-0321

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DS036510 PA Primary
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X DN017638 PA

Addresses

Primary practice location

430 Kenhorst Blvd
Reading, PA 19611-1830

Mailing address

430 Kenhorst Blvd
Reading, PA 19611-1830
Phone (610) 775-0321

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248652800000",
    "number": "1659509404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 KENHORST BLVD",
            "city": "READING",
            "state": "PA",
            "postal_code": "196111830",
            "telephone_number": "610-775-0321",
            "fax_number": "610-777-8884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 KENHORST BLVD",
            "city": "READING",
            "state": "PA",
            "postal_code": "196111830",
            "telephone_number": "610-775-0321",
            "fax_number": "610-777-8884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-30",
        "last_updated": "2009-07-27",
        "status": "A",
        "authorized_official_last_name": "MEDIANICK",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-775-0321",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS036510",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DN017638",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Reading, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2009; 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.