John Frazier Boutwell, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9855 Issued in SC

Practice address

3369 Pelham Rd
Greenville, SC 29615-4105

Phone

(864) 297-6365

NPI assigned

Jun 11, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Boutwell Dental, LLC

  • Dental Clinic/Center
  • Simpsonville, SC
  • NPI 1962281105
  NPD Authorized official

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

{
    "created_epoch": "1591833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1642636800000",
    "number": "1770108102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3369 PELHAM RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154105",
            "telephone_number": "864-297-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3369 PELHAM RD",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154105",
            "telephone_number": "864-297-6365"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "600 N Highway 190 Ste 4",
            "address_purpose": "LOCATION",
            "city": "Covington",
            "state": "LA",
            "postal_code": "704335083",
            "country_code": "US",
            "telephone_number": "985-893-5522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUTWELL",
        "first_name": "JOHN",
        "middle_name": "FRAZIER",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-11",
        "last_updated": "2022-01-20",
        "certification_date": "2022-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "LA",
            "license": "7099",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "9855",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chris George Boukedes, MD
• Cynthia Boulton, PHARMD
• Stephanie Bour, RN
• Bourg Chiropractic, LLC
• Michaela Rae Bourgeois
• Michael S Bovee, DC
• Ashlan Ferguson Bowen, NP
• Charles H Bowen, M.D.
• Nicole J Bowen
• Shelby Bowen

• Dentist in Greenville, SC
• Providers in Greenville, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; 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.

Verify at the official NPI Registry.