DR. SAMY WASFY BOULOS DDS
NPI 1275775348
Dentist - General Practice in Shoreview, MN

Q: What is Samy Boulos's NPI number?

The NPI number for Samy Boulos is 1275775348. It was assigned to this individual provider in the NPPES registry on April 3, 2009.

Q: What is Samy Boulos's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Q: When was this NPI record last updated?

The NPPES record for Samy Boulos was last updated on February 14, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 03, 2009PECOS Enrolled

470 HIGHWAY 96 W STE 200, SHOREVIEW, MN 55126(651) 366-6880(651) 366-6881 Get Directions Write a Review

NPPES record last updated: February 14, 2019. Verified against the NPPES registry weekly; last sync: August 23, 2026.

On this page

About Dr. Samy Wasfy Boulos Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SAMY WASFY BOULOS DDS (NPI 1275775348) is an individual general practice provider in Shoreview, Minnesota, licensed in Minnesota (D12329) and active in the NPI registry since April 2009. He is enrolled in Medicare PECOS and maintains a secondary practice location in Rogers.

NPPES Registry Identity

NPI1275775348

Entity TypeIndividualMale

Primary Taxonomy1223G0001X

Provider Legal NameDR. SAMY WASFY BOULOSCredential: DDS

Location Address470 HIGHWAY 96 W STE 200Shoreview, MN 55126-3214

Mailing Address470 Highway 96 W Ste 200Shoreview, MN 55126-3214 · (651) 366-6880 · Fax (651) 366-6881

Phone(651) 366-6880

Fax(651) 366-6881

Sole ProprietorNo

Enumeration DateApril 3, 2009

Last NPPES UpdateFebruary 14, 2019

✔ NPI 1275775348 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentist · General PracticeDental Providers

Taxonomy Code1223G0001X

License✔ Licensed in MN · D12329

Definition

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

470 HIGHWAY 96 W STE 200, Shoreview, MN 55126

Open in Google Maps ↗

Secondary Practice Location 1

Location 114000 Northdale Blvd Ste JRogers, MN 55374-4663 · Phone (763) 428-2300 · Fax (763) 428-4031

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Samy Wasfy Boulos Dds is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 55126 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$85.82 typical visit price

range $56.00 – $168.28

Typical copayment $21.45 (range $14.00 – $42.07)

Most-billed visit code 99203

Established Patient

$69.74 typical visit price

range $18.32 – $138.04

Typical copayment $17.43 (range $4.58 – $34.51)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MINA SAMY BOULOS DDS

Dentist (General Practice)

470 HIGHWAY 96 W STE 200
SHOREVIEW, MN 55126

Ramsey County (651) 366-6880

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Samy Boulos's NPI number?

The NPI number for Samy Boulos is 1275775348. It was assigned to this individual provider in the NPPES registry on April 3, 2009.

Where is Samy Boulos located?

Samy Boulos practices at 470 Highway 96 W Ste 200, Shoreview, MN 55126. The listed phone number is (651) 366-6880.

What is Samy Boulos's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

Is Samy Boulos enrolled in Medicare?

Yes. Samy Boulos is registered in the Medicare PECOS enrollment system.

What insurance does Samy Boulos accept?

Health plans from Anthem Blue Cross and Blue Shield, BEST Life, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 6 other insurers list Samy Boulos as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Samy Boulos was last updated on February 14, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.