ANDREW JON BOSWORTH, D.D.S. — NPI 1962850784 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in EXCELSIOR, MN)

CMS-1500 Box 24J / 33a • NPI

1962850784

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

122300000X (CMS C5)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

6140 LAKE LINDEN DR, SUITE #230, EXCELSIOR, MN, 55331-2954

✓ 9-Digit EDI 837 ZIP+4 (55331-2954)

Practice Phone & Referral Fax

(952) 474-4123

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1962850784 (ANDREW JON BOSWORTH, D.D.S.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1962850784` (NPI-1 Individual Practitioner)
Provider / Legal Name	ANDREW JON BOSWORTH, D.D.S.
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `122300000X` (Dentist)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	6140 LAKE LINDEN DR, SUITE #230, EXCELSIOR, MN, 55331-2954
Practice Telephone / Fax	Tel: (952) 474-4123
Administrative Mailing Address	6140 LAKE LINDEN DR, EXCELSIOR, MN, 55331-2954
Enumeration & Last Sync	Enumerated: 2016-06-02 \| CMS Record Updated: 2016-06-02

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

6140 LAKE LINDEN DR, SUITE #230, EXCELSIOR, MN, 55331-2954

🗺️ Open in Google Maps 🏥 More Providers in EXCELSIOR

🔒 Are you ANDREW JON BOSWORTH, D.D.S.? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (122300000X)

What Does Taxonomy Code 122300000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 122300000X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code C5 (Dentist)
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ANDREW JON BOSWORTH, D.D.S.)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`122300000X` — Dentist Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: MN \| License: `D13677` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.

Launch Bulk NPI Checker → JSON API Docs

ANDREW JON BOSWORTH, D.D.S. (NPI #1962850784)