DR. GREGORY BOULDIEN (NPI# 1013023837) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013023837 |
| Entity Type | Individual |
| Full Name | DR. GREGORY BOULDIEN |
| Credential | DDS MS |
| Practice Address |
9880 Goodman Rd Olive Branch MS 38654-1722 |
| Practice Telephone | 6624704919 |
| Practice Fax Number | 6628746295 |
| Mailing Telephone | 6624704919 |
| Mailing Fax Number | 6628746295 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
5213 | TN | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 7734 Airways Blvd, Southaven, MS 386715306 | 6623493838 | 6623495923 |
| 7675 Wolf River Cir Ste 102, Germantown, TN 381381747 | 9013638191 | 6623632774 |
| Street Address |
9880 GOODMAN RD |
| City | OLIVE BRANCH |
| State | MS |
| Zip Code | 38654-1722 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093366213 | Latonya Shontae Binion | Home Health | 5915 Brice Cove North, Olive Branch, MS 38654 | 2019-09-28 |
| 1356828677 | Heath Bryan Coleman, Dds of Mississippi II, Pllc | Dentist | 688 Goodman Rd, Ste 123, Olive Branch, MS 38654 | 2018-07-20 |
| 1629565684 | Alexis Summerville Mcdavis | Pharmacist | 7950 Craft Goodman Frontage Rd, Olive Branch, MS 38654 | 2018-04-16 |
| 1194237206 | Exos Physical Therapy and Sports Medicine, LLC | Physical Therapist | 6542 Goodman Rd, Olive Branch, MS 38654 | 2017-10-30 |
| 1609386515 | Laken Hood Richardson | Physical Therapist | 9085 East Sandidge Cove, Suite 250, Olive Branch, MS 38654 | 2017-10-05 |
| 1275064255 | Heart of Hospice, LLC | Hospice Care, Community Based | 9849 Highway 178 Unit B, Olive Branch, MS 38654 | 2017-03-22 |
| 1023557865 | Michael Patrick Mccallum | Counselor | 9320 Railroad Ave., Olive Branch, MS 38654 | 2017-02-13 |
| 1891179768 | Desoto Children's Clinic - Olive Branch | Pediatrics | 7145 Goodman Road, Olive Branch, MS 38654 | 2015-07-10 |
| 1891185203 | Kristina Harper | Midwife | 9086 Pigeon Roost Rd Ste C, Olive Branch, MS 38654 | 2015-01-23 |
| 1275955098 | Global Medical | Durable Medical Equipment & Medical Supplies | 6229 Hwy 305 Ste L, Olivebranch, MS 38654 | 2014-01-14 |
| Find all providers in zip 38654 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881200673 | Blake Denton Boleware | Dentist | 525 Thomastown Ln Ste A, Ridgeland, MS 39157-3440 | 2020-09-17 |
| 1386277291 | Smile Straight Orthodontics-central Ms Pllc | Dentist | 310 W Woodrow Wilson Ave Ste 400, Jackson, MS 39213-7697 | 2020-02-19 |
| 1225692213 | Roberts & Garza Orthodontics Services Pllc | Dentist | 946 Goodman Rd E, Southaven, MS 38671-8825 | 2019-04-25 |
| 1194294652 | Roberts & Garza Orthodontics Services Pllc | Dentist | 101 N Industrial Rd Ste H, Tupelo, MS 38801-3441 | 2018-11-14 |
| 1689157588 | Hop Orthodontics | Dentist | 120 S 28th Ave, Hattiesburg, MS 39401-7151 | 2018-09-07 |
| 1508359340 | Legendary Orthodontics, LLC | Dentist | 3225 Audubon Dr, Laurel, MS 39440-1422 | 2018-06-06 |
| 1790274603 | Gregory Goggans, D.m.d., P.C. | Dentist | 6420 Highway 11 N Ste C, Carriere, MS 39426-7146 | 2018-05-07 |
| 1114414802 | Magnolia Orthodontics | Dentist | 4348 Lincoln Road, Hattiesburg, MS 39402 | 2018-04-18 |
| 1598212623 | Edward Victor Brown Jr. | Dentist | 15465 Oak Lane, Gulfport, MS 39564 | 2016-09-07 |
| 1275086456 | Jessica Pongett | Dentist | 2408 S Lamar Blvd Ste 2, Oxford, MS 38655-5345 | 2016-07-25 |
| Find all providers with the same taxonomy | ||||
| City | OLIVE BRANCH |
| Zip Code | 38654 |
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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.