Kelly V Boulom, DDS in Sanger, CA - Medicare Dentist Provider

Kelly V Boulom, DDS is a medicare enrolled "Dentist - General Practice" provider in Sanger, California. His current practice location is 2432 Jensen Ave, Sanger, California. You can reach out to his office (for appointments etc.) via phone at (559) 875-5538.

Kelly V Boulom is licensed to practice in California (license number BB8039023) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1821169038.

Contact Information

	Kelly V Boulom, DDS
	2432 Jensen Ave, Sanger, CA 93657-2249
	(559) 875-5538
	Not Available

Healthcare Provider's Profile

Full Name	Kelly V Boulom
Gender	Male
Speciality	Dentist - General Practice
Location	2432 Jensen Ave, Sanger, California
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1821169038
Provider Enumeration Date: 11/10/2006
Last Update Date: 07/08/2007

Medicare PECOS Information:

PECOS PAC ID: 7012218720
Enrollment ID: I20151223000291

Medical Identifiers

Medical identifiers for Kelly V Boulom such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1821169038	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
1223G0001X	Dentist - General Practice	BB8039023 (California)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly V Boulom is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Kelly V Boulom, DDS 2713 Goshen Ave, Clovis, CA 93611-8177 Ph: (650) 515-1430	Kelly V Boulom, DDS 2432 Jensen Ave, Sanger, CA 93657-2249 Ph: (559) 875-5538

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Dentist in Sanger, CA

Dr. Herbert Lance Crooks, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 2434 Jensen, Sanger, CA 93657 Phone: 559-875-5538 Fax: 559-875-1575
Dr. Timothy Edward Prewitt, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 1615 7th St, Sanger, CA 93657 Phone: 559-875-3927
Dr. Kim Hoang Tran, D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 263 Academy Ave, Sanger, CA 93657 Phone: 559-876-1031 Fax: 559-876-1341
Ramandeep Gill, DDS Dentist Medicare: Medicare Enrolled Practice Location: 2432 Jensen Ave, Sanger, CA 93657 Phone: 559-875-5538
Myra R. Van Hoff, DDS Dentist Medicare: Medicare Enrolled Practice Location: 801 N St, Sanger, CA 93657 Phone: 559-876-1777 Fax: 559-876-2763
Donghwan Kim, DDS Dentist Medicare: Medicare Enrolled Practice Location: 1570 7th St, Sanger, CA 93657 Phone: 800-492-4227
Gary Larsen, Dentist Medicare: Not Enrolled in Medicare Practice Location: 1939 Academy Ave, Sanger, CA 93657 Phone: 559-875-6900

Kelly V Boulom, DDS - Medicare Dentist in Sanger, CA