Brock Cameron Boudreaux, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D010791 Issued in AZ

Practice address

8401 E 22ND St
Tucson, AZ 85710-6500

Phone

(520) 885-5746

NPI assigned

Jun 4, 2020

Last updated

Sep 3, 2020By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Robert Collier D.D.S., L.L.C.

  • Dentist
  • Tucson, AZ
  • NPI 1023186475
  NPD (past)

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

{
    "created_epoch": "1591228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1861016966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8401 E 22ND ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857106500",
            "telephone_number": "801-471-5615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 E 22ND ST",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857106500",
            "telephone_number": "520-885-5746"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "899 N Wilmot Rd # 2",
            "address_purpose": "LOCATION",
            "city": "Tucson",
            "state": "AZ",
            "postal_code": "857111714",
            "country_code": "US",
            "telephone_number": "520-214-4890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "BROCK",
        "middle_name": "CAMERON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-04",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D010791",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Esta Carline Bottorff, L.P.N.
• Jenna Bottorff, RN
• Rylan Bottrell
• Jacques Boubeka, BHT
• Irina Boucher
• Stacey Bouffard, PH.D.
• Boulder Surgical Services, LLC
• Theresa Suzanne Bouldin, RD, CSG
• John E. Boulet, MD
• Patrick Bouley, P.T.

• General Practice Dentistry in Tucson, AZ
• Providers in Tucson, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; 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.