Shawn A Boudreaux

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6841 Issued in SC

Practice address

12313 Greenville Hwy
Lyman, SC 29365-1515

Phone

(864) 439-3322

NPI assigned

Apr 4, 2018

Last updated

Apr 29, 2026By the provider in NPPES

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

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.

• Annette D Theriot DDS & Bryan P Daigle DDS

  • General Practice Dentistry
  • Hammond, LA
  • NPI 1659432755
  NPD (past)
• Mission Dental Mobile LLC

  dba Miles of Smiles

  • Dentist
  • Bessemer, AL
  • NPI 1205694932
  NPD (past)

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1777420800000",
    "number": "1952807380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 THELMA DR",
            "city": "SUNSET",
            "state": "LA",
            "postal_code": "705845430",
            "telephone_number": "337-308-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12313 GREENVILLE HWY",
            "city": "LYMAN",
            "state": "SC",
            "postal_code": "293651515",
            "telephone_number": "864-439-3322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAUX",
        "first_name": "SHAWN",
        "middle_name": "A",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-04",
        "last_updated": "2026-04-29",
        "certification_date": "2026-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "6841",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth M. Arms, LPC
• As We Speech Therapy Services
• Ashlan Village Retirement Community
• Levi H Barker
• Emily Nilsson Benjamin, COTA/L
• Susan Elizabeth Boykin, ACSW, LISW-CP
• Darin Lee Bright
• Gregory Kent Brown Jr., D.C.
• Nichole Parris Brown, D.C.
• Bruce Chiropractic Wellness Center

• General Practice Dentistry in Lyman, SC
• Providers in Lyman, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2026; 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.