KELLY V BOULOM (NPI# 1821169038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821169038 |
| Entity Type | Individual |
| Full Name | KELLY V BOULOM |
| Credential | DDS |
| Practice Address |
2432 Jensen Ave Sanger CA 93657-2249 |
| Mailing Address |
2713 Goshen Ave Clovis CA 93611-8177 |
| Practice Telephone | 5598755538 |
| Mailing Telephone | 6505151430 |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223G0001X |
Dentist Specialization: General Practice |
BB8039023 | CA | Dental Providers |
| Street Address |
2432 JENSEN AVE |
| City | SANGER |
| State | CA |
| Zip Code | 93657-2249 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568871853 | Bernardo Bretado | Counselor | 2017 Mary Street, Sanger, CA 93657 | 2014-08-12 |
| 1902238033 | Robin Christine Ploharz | Counselor | 1822 Jensen Ave #102-104, Sanger, CA 93657 | 2013-07-31 |
| 1629419833 | Elim Place, Inc. | Assisted Living Facility | 1808 5th Street, Sanger, CA 93657 | 2013-07-16 |
| 1568716793 | Paul Sylvan Cheney | Dentist | 620 S. Fairbanks Ave., Sanger, CA 93657 | 2012-11-09 |
| 1336409820 | Jocelyn Ann Mizunaka | Family Medicine | 1570 7th Street, Sanger, CA 93657 | 2012-05-18 |
| 1912216581 | Sampath Wijesinghe | Physician Assistant | 1393 Academy Ave, Sanger, CA 93657 | 2010-09-30 |
| 1528144185 | Daniel Richard Souza | Physical Therapist | 2570 Jensen A Ve #108, Sanger, CA 93657 | 2006-10-27 |
| 1023102654 | Herbert Lance Crooks | Dentist | 2434 Jensen, Sanger, CA 93657 | 2006-10-03 |
| 1689633174 | Donald T Negri Od Inc | Optometrist | 1329 8th St, Sanger, CA 93657 | 2006-03-22 |
| 1265400410 | Gurinder Pal Singh Narain | Internal Medicine | 800 N Street, Sanger, CA 93657 | 2006-03-14 |
| Find all providers in zip 93657 | ||||
| Taxonomy Code | 1223G0001X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | General Practice |
| A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. |
| Notes: Source: Academy of General Dentistry |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164082483 | Donghwan Kim | Dentist | 1570 7th St, Sanger, CA 93657-2402 | 2019-06-18 |
| 1043783657 | Sanger Dental-sanger Pllc | Dentist | 617 N 10th St Ste 204, Sanger, TX 76266-4241 | 2019-01-07 |
| 1265962310 | Neal B Bhatt | Dentist | 551 N. Stemmons St., Suite, Sanger, TX 76266-7626 | 2017-06-12 |
| 1811445000 | Sanger Dental Pllc | Dentist | 617 N 10th St, 204/205, Sanger, TX 76266-4240 | 2016-09-15 |
| 1710352679 | Karam Um Dds Inc | Dentist | 1329 8th St Ste 4, Sanger, CA 93657-3171 | 2015-12-03 |
| 1740666049 | Ronald Dye | Dentist | 10490 Gregory Road, Sanger, TX 76266 | 2015-08-10 |
| 1568716793 | Paul Sylvan Cheney | Dentist | 620 S. Fairbanks Ave., Sanger, CA 93657 | 2012-11-09 |
| 1942334313 | Randall Eugene Prewitt | Dentist | 1615 7th St, Sanger, CA 93657-2801 | 2007-03-15 |
| 1689717670 | Benjamin Lennis Smith IIi | Dentist | 107 South Stemmons, Sanger, TX 76266-0898 | 2007-02-15 |
| 1568501872 | Deogsoo Roh | Dentist | 625 P St, Sanger, CA 93657-2823 | 2007-02-05 |
| Find all providers in SANGER | ||||
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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.