Provider Demographics
NPI:1326414525
Name:ZHANG, BO
Entity Type:Individual
Prefix:
First Name:BO
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-3442
Mailing Address - Country:US
Mailing Address - Phone:316-283-0870
Mailing Address - Fax:
Practice Address - Street 1:229 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-3442
Practice Address - Country:US
Practice Address - Phone:316-283-0870
Practice Address - Fax:316-283-1430
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist