Clint Boyle, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019028642 Issued in IL

Practice address

107 S Prospect Rd
Bloomington, IL 61704-4403

Phone

(309) 663-0433

NPI assigned

Aug 4, 2011

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

Enrolled in IL

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

Practice roles

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.

• Maple Shade Dental Bloomington LLC

  • Dentist
  • Bloomington, IL
  • NPI 1366795437
  NPD (past)

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

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1851670152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 S PROSPECT RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617044403",
            "telephone_number": "309-663-0433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 S PROSPECT RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617044403",
            "telephone_number": "309-663-0433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYLE",
        "first_name": "CLINT",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-04",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019028642",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chad Bowcott
• Bowers Orthodontic Specialists
• Kurt T. Bowers, D.D.S.
• Gail Anne Bowlin, MS, CADC, LCPC
• Deron Kieth Boyer, M.A.
• Julia Madden Bozarth, LCPC
• Samantha Bozarth, CCC-SLP
• Brenden Brack
• Bailey Bradish, PTA
• Bethany Ann Bradley, CNM

• Dentist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; 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.