Active NPI
Joanna Lea Boutwell, DDS
- General Practice Dentistry
- Simpsonville, SC
National Provider Identifier
1972255073
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 9885
- Practice address
- 504 Foxwild CT
Simpsonville, SC 29681-7299 - Phone
- (318) 680-8226
- NPI assigned
- Jan 20, 2022
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 9885 | SC | Primary |
Addresses
Primary practice location
504 Foxwild CT
Simpsonville, SC 29681-7299
Mailing address
504 Foxwild CT
Simpsonville, SC 29681-7299
Phone (318) 680-8226
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 |
|---|---|---|---|
| 9885 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1642636800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1642636800000",
"number": "1972255073",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 FOXWILD CT",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296817299",
"telephone_number": "318-680-8226"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "504 FOXWILD CT",
"city": "SIMPSONVILLE",
"state": "SC",
"postal_code": "296817299",
"telephone_number": "318-680-8226"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOUTWELL",
"first_name": "JOANNA",
"middle_name": "LEA",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-01-20",
"last_updated": "2022-01-20",
"certification_date": "2022-01-20",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "9885",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Simpsonville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.