Boulevard Dental Care L.L.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

BOULEVARD DENTAL CARE L.L.C.

Practice address

2645 Muegge Rd
Saint Charles, MO 63303-3145

Phone

(636) 939-6868

Fax

(636) 447-3611

NPI assigned

Jan 7, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Randall Craig Reyes, D.M.D.NPI 1154479285

Title

Manager

Phone

(636) 939-6868

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Randall Craig Reyes, D.M.D.

  • General Practice Dentistry
  • Saint Charles, MO
  • NPI 1154479285

  General Practice

  NPD (past) Authorized official

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

{
    "created_epoch": "1168128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185753600000",
    "number": "1831247048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11939 MANCHESTER RD",
            "address_2": "#120",
            "city": "DES PERES",
            "state": "MO",
            "postal_code": "631314502",
            "telephone_number": "636-939-6868",
            "fax_number": "636-447-3611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 MUEGGE RD",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633033145",
            "telephone_number": "636-939-6868",
            "fax_number": "636-447-3611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULEVARD DENTAL CARE L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-07",
        "last_updated": "2007-07-30",
        "status": "A",
        "authorized_official_last_name": "REYES",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "CRAIG",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "636-939-6868",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Borello & Rieser Dental
• Clare Elizabeth Borello, DDS
• David C Bortfeld, P.T.
• Jocelyn Jeanne Bosch, OT
• Cynthia Lee Boschert, LPC
• Michael Bournstein, LPC
• Matthew Bowden, ATC
• Kristen Diane Bowdern
• Mary Beth Bowman, LCSW
• Natalie Grace Bowman

• All providers in Saint Charles, MO
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 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.