Active NPI
Jodi Shannon Boling, D.D.S.
- Dentist
- Jonesboro, AR
National Provider Identifier
1720410806
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 3950
- Practice address
- 2704 E Nettleton Ave
Jonesboro, AR 72401-4529 - Phone
- (870) 932-9886
- NPI assigned
- Jul 31, 2013
- Last updated
- Jan 26, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 3950 | AR | Primary |
Addresses
Primary practice location
2704 E Nettleton Ave
Jonesboro, AR 72401-4529
Mailing address
2704 E Nettleton Ave
Jonesboro, AR 72401-4529
Phone (870) 932-9886
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160126001369 | AR | Order and Referring Only - Dentist | 9739482746 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3950 | AR | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1375228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1453766400000",
"number": "1720410806",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2704 E NETTLETON AVE",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724014529",
"telephone_number": "870-932-9886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2704 E NETTLETON AVE",
"city": "JONESBORO",
"state": "AR",
"postal_code": "724014529",
"telephone_number": "870-932-9886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOLING",
"first_name": "JODI",
"middle_name": "SHANNON",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-07-31",
"last_updated": "2016-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AR",
"license": "3950",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jonesboro, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2016; 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.