MEDICARE: TERRY L BOONE DDS, PA

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	261QD0000X	Dental Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609471895
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TERRY L BOONE DDS, PA

Provider Business Mailing Address
First Line	:	7197 SHERIDAN RD STE 115
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3261
Country	:	US
Telephone Number	:	870-267-1423
Fax Number	:	870-267-1424

Provider Business Practice Location Address
First Line	:	7197 SHERIDAN RD STE 115
Second Line	:
City	:	WHITE HALL
State	:	AR
Zip	:	71602-3261
Country	:	US
Telephone Number	:	870-267-1423
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TERRY L BOONE
Credential	:	D.D.S.,M.S
Telephone Number	:	870-267-1423

Provider Enumeration Date	:	12/03/2020
Last Update Date	:	12/08/2020

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