Provider Demographics
NPI:1215013610
Name:BOSQUE FAMILY AND COSMETIC DENTISTRY LLC
Entity Type:Organization
Organization Name:BOSQUE FAMILY AND COSMETIC DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-869-6500
Mailing Address - Street 1:2280 BOSQUE FARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:BOSQUE FARMS
Mailing Address - State:NM
Mailing Address - Zip Code:87068-9334
Mailing Address - Country:US
Mailing Address - Phone:505-869-6500
Mailing Address - Fax:505-869-4036
Practice Address - Street 1:2280 BOSQUE FARMS BLVD
Practice Address - Street 2:
Practice Address - City:BOSQUE FARMS
Practice Address - State:NM
Practice Address - Zip Code:87068-9334
Practice Address - Country:US
Practice Address - Phone:505-869-6500
Practice Address - Fax:505-869-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty