Active NPI
George Howard Bouldien, DDSMS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Germantown, TN
National Provider Identifier
1902199466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 1712
- Practice address
- 3100 Professional PLZ
Germantown, TN 38138-7915 - Phone
- (901) 755-3354
- NPI assigned
- May 17, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 1712 | TN | Primary |
Addresses
Primary practice location
3100 Professional PLZ
Germantown, TN 38138-7915
Mailing address
3100 Professional PLZ
Germantown, TN 38138-7915
Phone (901) 755-3354
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1712 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1305590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1305590400000",
"number": "1902199466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 PROFESSIONAL PLZ",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381387915",
"telephone_number": "901-755-3354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3100 PROFESSIONAL PLZ",
"city": "GERMANTOWN",
"state": "TN",
"postal_code": "381387915",
"telephone_number": "901-755-3354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOULDIEN",
"first_name": "GEORGE",
"middle_name": "HOWARD",
"name_prefix": "Dr.",
"credential": "DDSMS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-05-17",
"last_updated": "2011-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "TN",
"license": "1712",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Germantown, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.