MEDICARE: DR. JAMES E. BOULTON D.D.S.

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	1223E0200X	Endodontics	DS-3169	TN

General Provider Information

NPI Number	:	1235148024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E. BOULTON D.D.S.

Provider Business Mailing Address
First Line	:	2292 CHAMBLISS AVE NW
Second Line	:	SUITE B
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3862
Country	:	US
Telephone Number	:	423-476-7600
Fax Number	:	423-476-3949

Provider Business Practice Location Address
First Line	:	2292 CHAMBLISS AVE NW
Second Line	:	SUITE B
City	:	CLEVELAND
State	:	TN
Zip	:	37311-3862
Country	:	US
Telephone Number	:	423-476-7600
Fax Number	:	423-476-3949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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