Boulder Rock Dental, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN15016 Issued in FL

Legal business name

BOULDER ROCK DENTAL, LLC

Practice address

5 Boulder Rock Dr Ste a
Palm Coast, FL 32137-8538

Phone

(386) 931-1685

NPI assigned

Jan 8, 2018

Organization subpart

No

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

Authorized official

Name

Tanya Whitaker

Title

Office Manager

Phone

(386) 276-9051

Specialties & licenses 1

Addresses

Locations

Practitioners 4

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

• Tyler Scott Flynn, DMD

  • Dentist
  • Palm Coast, FL
  • NPI 1205459153

  General Practice

  NPD
• Frederick A Fox, DDS

  • Dentist
  • Palm Coast, FL
  • NPI 1568589240
  NPD
• Thomas Huntley, DMD

  • General Practice Dentistry
  • Palm Coast, FL
  • NPI 1821649039
  NPD
• Daniel Kortyka, DMD

  • Dentist
  • Winter Springs, FL
  • NPI 1184356917
  NPD (past)

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

{
    "created_epoch": "1515369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718150400000",
    "number": "1922515204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 BOULDER ROCK DR STE A",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378538",
            "telephone_number": "386-276-9051",
            "fax_number": "386-276-9053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 BOULDER ROCK DR STE A",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378538",
            "telephone_number": "386-931-1685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER ROCK DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-08",
        "last_updated": "2024-06-12",
        "certification_date": "2024-06-12",
        "status": "A",
        "authorized_official_last_name": "WHITAKER",
        "authorized_official_first_name": "TANYA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "386-276-9051"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN15016",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Borg, PH.D.
• Tracy Lynn Bossbach
• Ramez Rashad Halim Botros
• Jennifer Marie Bottke, FNP-BC
• Mary Bottom, COTA
• Kaitlynn Bourne
• Jennifer Bova
• James Bowe
• Steven C. Bower, M.D.
• Lakshmi Boyapati, MD

• General Practice Dentistry in Palm Coast, FL
• Providers in Palm Coast, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2024; 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.