MEDICARE: DAVID L. BOONE, DDS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3924	OK

General Provider Information

NPI Number	:	1588840128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID L. BOONE, DDS, INC.

Provider Business Mailing Address
First Line	:	519 S 30TH ST
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3632
Country	:	US
Telephone Number	:	580-323-1177
Fax Number	:	580-323-1178

Provider Business Practice Location Address
First Line	:	519 S 30TH ST
Second Line	:
City	:	CLINTON
State	:	OK
Zip	:	73601-3632
Country	:	US
Telephone Number	:	580-323-1177
Fax Number	:	580-323-1178

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	DR. DAVID LYNN BOONE
Credential	:	DDS
Telephone Number	:	580-323-1177

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	05/13/2014

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