Provider Demographics
NPI:1073929147
Name:GARCIA BOSS, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:GARCIA BOSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6403 4TH ST E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-6001
Mailing Address - Country:US
Mailing Address - Phone:786-499-1236
Mailing Address - Fax:
Practice Address - Street 1:8441 HERITAGE GREEN WAY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-1400
Practice Address - Country:US
Practice Address - Phone:941-741-8888
Practice Address - Fax:941-741-8903
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN216731223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice