Owen J Boales, D.M.D.
Individual provider Active NPI General Practice Dentistry · Jasper, FL
NPI 1982720520 · NPPES record last updated Feb 2, 2023
Key facts
- NPI
- 1982720520
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- D8791 (FL)
- Practice address
- 1133 4TH St NW
Jasper, FL 32052-5847 - Phone
- (386) 792-1197
- Fax
- (386) 792-1048
- NPI assigned
- Mar 22, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150629002593 | FL | Order and Referring Only - Dentist |
7214249515 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D8791 | FL | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comfortable Care Dental Health Professionals, P.a. | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | D8791 | FL | Yes |
Addresses
Primary practice location
1133 4TH St NW
Jasper, FL 32052-5847
Mailing address
1133 4TH St NW
Jasper, FL 32052-5847
Phone (386) 792-1197
Other providers in Jasper, FL
- Advantage Home Medical Equipment, Inc.
- Robyn Allen
- B a R Medical Corporation
- Irvin Carlyle Bembry
- Betty Manning Bridges
- Dorothy Lorraine Buffington
- Cason Hall Burnett
- Caitlin Christine Charette-Zalewski
- Cheek & Scott Drugs Inc
All providers in Jasper, FL · General Practice Dentistry in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 2, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.