Bradley Boeke, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

13526 Issued in TX

Practice address

4624 Lakeview Pkwy
Rowlett, TX 75088-4027

Phone

(972) 840-2020

Fax

(972) 694-0260

NPI assigned

Feb 20, 2007

Last updated

Jun 21, 2017By the provider in NPPES

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

Enrolled in TX

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bayside Radiology and Imaging of Rowlett PLLC

  dba Bayside Radiology and IMaging

  • Radiology Clinic/Center
  • Rowlett, TX
  • NPI 1861961815
  NPD

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1498003200000",
    "number": "1770628539",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4624 LAKEVIEW PKWY",
            "city": "GARLAND",
            "state": "TX",
            "postal_code": "750884027",
            "telephone_number": "972-840-2020",
            "fax_number": "972-694-0260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4624 LAKEVIEW PKWY",
            "city": "ROWLETT",
            "state": "TX",
            "postal_code": "750884027",
            "telephone_number": "972-840-2020",
            "fax_number": "972-694-0260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEKE",
        "first_name": "BRADLEY",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2017-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "13526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mariah Blanco
• Meridith L Blanford, CFA
• Christopher Aaron Boatwright I, LPC INTERN
• Body Mind Soul Healing PLLC
• Boeke & Associates, PA (Bayside Dental Rowlett)
• George A Bogard, DDS
• Paulette Bohannon, SA-C
• Hilary Dawn Bontrager, COTA
• Amelia Noel Borden
• Mark Wayne Boren, DDS

• General Practice Dentistry in Rowlett, TX
• Providers in Rowlett, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2017; 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.