David F. Boden, D.D.S., M.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

10253 Issued in FL

Practice address

1100 SW Saint Lucie West Blvd
Suite #104
Port St Lucie, FL 34986-1780

Phone

(772) 878-2000

Fax

(772) 878-2807

NPI assigned

Apr 20, 2007

Last updated

Jul 8, 2007By 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 FL

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

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1821215526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 SW SAINT LUCIE WEST BLVD",
            "address_2": "SUITE #104",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861780",
            "telephone_number": "772-878-2000",
            "fax_number": "772-878-2807"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SW SAINT LUCIE WEST BLVD",
            "address_2": "SUITE #104",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861780",
            "telephone_number": "772-878-2000",
            "fax_number": "772-878-2807"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODEN",
        "first_name": "DAVID",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "FL",
            "license": "10253",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• BNG Enterprises, Inc. (Care Connect Transport)
• Tammy Rena Boatright
• Megan Bock
• Jenny Paola Bodden Martinez, MS, BS
• Patricia Malvoisin Boddie, M.S., LMHC
• Haren Bodepudi, M.D.
• Carol E. Boettcher, ARNP
• Samantha R Bogle, DMD
• Jennifer Kathleen Bogus
• Gordon George Bohl, LCSW

• Periodontics in Port St Lucie, FL
• Providers in Port St Lucie, FL by specialty
• Periodontics in Florida

• 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.
• 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.