Travis Boyer, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

00202790 Issued in CO

Practice address

716 Yellowstone Ave
Pocatello, ID 83201-4407

Phone

(208) 478-5437

NPI assigned

Aug 8, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522108800000",
    "number": "1992715304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 S ORCHARD SPRINGS DR STE 110",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810076154",
            "telephone_number": "719-924-8858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "716 YELLOWSTONE AVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832014407",
            "telephone_number": "208-478-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOYER",
        "first_name": "TRAVIS",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-08",
        "last_updated": "2018-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3896",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CO",
            "license": "00202790",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807402500",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07178506",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200533690A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas J Box, P.A.
• Alisha Janette Boyce, LCSW
• Richard Boyce
• Colten Boyd, DNP
• Kraig Boyd, LPC
• Julia Boyle, PHARMD
• Renee Lynn Bozorg-Omid, LPC
• Brace Place LTD
• Andrew Bradbury, MD
• Melissa Bradley, LMT

• General Practice Dentistry in Pocatello, ID
• Providers in Pocatello, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.