Provider Demographics
NPI:1497139406
Name:BOULES, AMIR (DMD)
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:
Last Name:BOULES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10427 ULMERTON RD
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-3530
Mailing Address - Country:US
Mailing Address - Phone:727-535-9993
Mailing Address - Fax:
Practice Address - Street 1:10427 ULMERTON RD
Practice Address - Street 2:SUITE B-3
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3530
Practice Address - Country:US
Practice Address - Phone:727-535-9993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 21457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist