John Edwin Boland IV, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

39515 Issued in CA

Practice address

770 Tamalpais Dr Ste 404
Corte Madera, CA 94925-1739

Phone

(415) 927-9052

Fax

(415) 927-2231

NPI assigned

Feb 13, 2007

Sex

Male

Sole proprietor

Yes

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": "1171324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740322767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "770 TAMALPAIS DR STE 404",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251739",
            "telephone_number": "415-927-9052",
            "fax_number": "415-927-2231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 TAMALPAIS DR STE 404",
            "city": "CORTE MADERA",
            "state": "CA",
            "postal_code": "949251739",
            "telephone_number": "415-927-9052",
            "fax_number": "415-927-2231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLAND",
        "first_name": "JOHN",
        "middle_name": "EDWIN",
        "name_prefix": "Dr.",
        "name_suffix": "IV",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "39515",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Omri Berger, M.D.
• Barbara Berman, PSY 15396
• Emily Jo Bernard, AUD
• Anne K Bjork
• Martin Block, PH.D.
• John Edwin Boland III, DDS
• Darby Furth Bonomi, PH.D.
• Steven S Bordunov, DC
• Edwin B. Bottum-Morgan, PH.D.
• Marion Katherine Brennan, LCSW

• All providers in Corte Madera, CA
• Dentist in California

• 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.