Provider Demographics
NPI:1376610345
Name:BOESCH, CHRISTINA SUZANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:SUZANNE
Last Name:BOESCH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 S JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-5021
Mailing Address - Country:US
Mailing Address - Phone:407-857-0950
Mailing Address - Fax:407-857-0893
Practice Address - Street 1:5155 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-5021
Practice Address - Country:US
Practice Address - Phone:407-857-0950
Practice Address - Fax:407-857-0893
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN15940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist