Active NPI
Gunnar Anton Boelman, DMD
- General Practice Dentistry
- Fort Worth, TX
National Provider Identifier
1982220562
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 36216
- Practice address
- 3400 Texas Sage TRL Ste 136
Fort Worth, TX 76177-8604 - Phone
- (817) 750-1300
- NPI assigned
- Jun 19, 2020
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 36216 | TX | Primary |
Addresses
Primary practice location
3400 Texas Sage TRL Ste 136
Fort Worth, TX 76177-8604
Mailing address
3205 Sadie TRL
Fort Worth, TX 76137-6683
Phone (909) 548-9979
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 |
|---|---|---|---|
| 36216 | TX | MD | Speech-Language Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592524800000",
"number": "1982220562",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3205 SADIE TRL",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761376683",
"telephone_number": "909-548-9979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3400 TEXAS SAGE TRL STE 136",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761778604",
"telephone_number": "817-750-1300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOELMAN",
"first_name": "GUNNAR",
"middle_name": "ANTON",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-06-19",
"last_updated": "2020-06-19",
"certification_date": "2020-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "36216",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 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.