Paul R Boldt, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 10882 Issued in FL

Practice address

751 Oak St
Suite 601
Jacksonville, FL 32204-3359

Phone

(904) 355-2666

NPI assigned

Oct 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

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": "1191283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191283200000",
    "number": "1992992028",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 350760",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322350760",
            "telephone_number": "904-608-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 OAK ST",
            "address_2": "SUITE 601",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322043359",
            "telephone_number": "904-355-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLDT",
        "first_name": "PAUL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-02",
        "last_updated": "2007-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 10882",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bold City Orthotics and Prosthetics, LLC
• Bold City Therapy and Wellness LLC
• Bold Healthcare PLLC
• Tiffany Bolden
• Irina Eugenievna Boldt, M.D.
• Lucy Bolerjack, DO
• Kathryn Susanne Boles, D.O.
• Rachel Amanda Bolger, PT, DPT
• William E Bolger, M.D.
• Kylee Waynette Bolibrzuch, MSW

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2007; 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.