Active NPI
Tyler Tilden Boynton, D.M.D.
- Oral and Maxillofacial Surgery (Dentist)
- Sonoma, CA
National Provider Identifier
1992934475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 63259
- Practice address
- 378 Perkins St
Sonoma, CA 95476-6827 - Phone
- (707) 996-4519
- NPI assigned
- Jul 6, 2009
- Last updated
- Jun 12, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 63259 | CA | Primary |
Addresses
Primary practice location
378 Perkins St
Sonoma, CA 95476-6827
Mailing address
378 Perkins St
Sonoma, CA 95476-6827
Phone (707) 996-4519
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 7, 2015 through Apr 7, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 63259 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1246838400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402531200000",
"number": "1992934475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "378 PERKINS ST",
"city": "SONOMA",
"state": "CA",
"postal_code": "954766827",
"telephone_number": "707-996-4519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "378 PERKINS ST",
"city": "SONOMA",
"state": "CA",
"postal_code": "954766827",
"telephone_number": "707-996-4519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOYNTON",
"first_name": "TYLER",
"middle_name": "TILDEN",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-06",
"last_updated": "2014-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "CA",
"license": "63259",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sonoma, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.