DR. BOUALI FREDERICK AMOLI (NPI# 1306073754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306073754 |
| Entity Type | Individual |
| Full Name | DR. BOUALI FREDERICK AMOLI |
| Credential | D.M.D. M.D. |
| Practice Address |
5149 Normandy Blvd Unit 4 Jacksonville FL 32205-4861 |
| Practice Telephone | 9047811201 |
| Mailing Telephone | 9047811201 |
| Enumeration Date | 2009-06-12 |
| Last Update Date | 2015-02-23 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DN 21029 | FL | Dental Providers |
| N | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
DRP781 | FL | Dental Providers |
| N | 204E00000X | Oral & Maxillofacial Surgery | ME119684 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | 012224600 | 05 |
| Street Address |
5149 NORMANDY BLVD UNIT 4 |
| City | JACKSONVILLE |
| State | FL |
| Zip Code | 32205-4861 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235612730 | Siraj K Asadi | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2018-09-11 |
| 1982057444 | Akhil Dubey | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2016-07-20 |
| 1336591452 | Jay St Charles II | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2016-07-13 |
| 1619329570 | Grettel Recillez Lopez | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2016-07-05 |
| 1841673126 | Joseph E. Smillie | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2015-07-03 |
| 1245611342 | Sebastien Murphy | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2015-06-15 |
| 1720496144 | Deshaydia Boykin | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2014-07-29 |
| 1740544972 | Toni-ann Hylton Mayembe | Dentist | 5149 Normandy Blvd Unit 4, Jacksonville, FL 32205-4861 | 2012-07-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003466830 | Brandon Neil Hillard | Registered Nurse | 1260 Mcduff Ave. South, Suite 4, Jacksonville, FL 32205 | 2019-09-13 |
| 1720436363 | Ericka Sampson | Massage Therapist | 6859 Lenox Ave., Suite 6, Jacksonville, FL 32205 | 2016-05-24 |
| 1578921631 | Northstar Counseling | Counselor | 1672 Pershing Rd, Jacksonville, FL 32205 | 2016-02-04 |
| 1649645144 | Magaly Perez-cruz | Speech-Language Pathologist | 4101-1 College Street, Jacksonville, FL 32205 | 2015-12-09 |
| 1639448723 | First Choice Adult Daycare and Home Health Ca | Specialist | 5336 Quan Drive, Jacksonville, FL 32205 | 2011-12-20 |
| 1437434222 | Christopher Styer | Pharmacist | 654 Casset Ave, Jacksonville, FL 32205 | 2011-10-12 |
| 1871827279 | April Marie Felton | Nurse Practitioner | 500 E. Adams Street, Bay Street Health Center, Jacksonville, FL 32205 | 2009-10-01 |
| 1922244821 | Danielle Marie Sergent | Physical Therapist | 5222 Lenox Ave., Jacksonville, FL 32205 | 2008-12-23 |
| 1427181775 | Lapp & Associates Behavioral Counselind Ctr | Counselor | 931 Cassat Avenue, Jacksonville, FL 32205 | 2007-03-14 |
| 1629143326 | Elias Moussa Sargi | Dentist | 2700 Riverside Avenue, Ste 10, Jacksonville, FL 32205 | 2006-11-21 |
| Find all providers in zip 32205 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154760411 | Tyler J Holley | Dentist | University of Florida- Jacksonville, 653-1 West 8th Street, Jacksonville, FL 32209 | 2013-06-20 |
| 1851602734 | Carlo Enrico Guevara | Dentist | 4540 Southside Blvd Ste 1001, Jacksonville, FL 32216-5495 | 2010-06-25 |
| 1154555035 | Salam Omar Salman | Dentist | 653 W. 8th Street, Uf - Jacksonville Dept. of Oral & Maxillofacial Surgery, Jacksonville, FL 32209 | 2009-05-07 |
| 1316151301 | Scott Roberts Sklenicka | Dentist | 2511 Saint Johns Bluff Rd S, Suite 207, Jacksonville, FL 32246-2346 | 2007-05-09 |
| 1851417406 | North Florida Oral & Facial Surgery, P.a. | Dentist | 11481 Old Saint Augustine Rd Ste 203, Jacksonville, FL 32258-1475 | 2007-03-22 |
| 1992832059 | Vanni Russ Strenta | Dentist | 3914 Blanding Blvd, Jacksonville, FL 32210-5413 | 2007-02-27 |
| 1184760480 | Gregory Joseph Groshan | Dentist | 3007 Hartley Rd, Jacksonville, FL 32257-6201 | 2007-01-30 |
| 1477606267 | Gregory W Hartley | Dentist | 4181 Southpoint Dr E, Suite 200, Jacksonville, FL 32216-0993 | 2007-01-18 |
| 1366591265 | Pairot Tayapongsak | Dentist | 7101 Normandy Blvd, Jacksonville, FL 32205-6211 | 2007-01-09 |
| 1578622908 | Jason Lee | Dentist | 13820 Old St Augustine Rd, Suite 105, Jacksonville, FL 32258 | 2006-12-08 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 32205 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.