Provider Demographics
NPI:1477029742
Name:BOSS DENTISTRY LLC
Entity Type:Organization
Organization Name:BOSS DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-451-9064
Mailing Address - Street 1:553 SHILOH PIKE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-1405
Mailing Address - Country:US
Mailing Address - Phone:856-451-9064
Mailing Address - Fax:856-451-8414
Practice Address - Street 1:553 SHILOH PIKE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-1405
Practice Address - Country:US
Practice Address - Phone:856-451-9064
Practice Address - Fax:856-451-8414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental