Peter D. Boulden, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN012542 Issued in GA

Practice address

1875 Old Alabama Rd
Suite 130
Roswell, GA 30076-2201

Phone

(770) 998-3838

Fax

(770) 998-3865

NPI assigned

Nov 22, 2006

Sex

Male

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

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689749657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1875 OLD ALABAMA RD",
            "address_2": "SUITE 130",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300762201",
            "telephone_number": "770-998-3838",
            "fax_number": "770-998-3865"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1875 OLD ALABAMA RD",
            "address_2": "SUITE 130",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300762201",
            "telephone_number": "770-998-3838",
            "fax_number": "770-998-3865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOULDEN",
        "first_name": "PETER",
        "middle_name": "D.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN012542",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Lanette Booth
• Alison Elise Borganelli, PT, DPT
• Eileen Borkovich, APRN
• Bruce Eric Bosse, MD
• Maria Bougiamas, DNP
• Sara Bouman, LPC
• Tim Bouman, LPC
• Katrina Marie Bowden, AU.D
• Lindsay Bowen, M.ED, CF- SLP
• Terra McDonald Bowers, P.A.

• General Practice Dentistry in Roswell, GA
• Providers in Roswell, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.