Provider Demographics
NPI:1326124728
Name:BOGHOSIAN, ALICE G (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALICE
Middle Name:G
Last Name:BOGHOSIAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-5161
Mailing Address - Country:US
Mailing Address - Phone:847-692-7760
Mailing Address - Fax:847-730-3020
Practice Address - Street 1:101 S WASHINGTON AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4200
Practice Address - Country:US
Practice Address - Phone:847-692-7760
Practice Address - Fax:847-692-2264
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190195831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice