Provider Demographics
NPI:1578121745
Name:ZHANG, BOSHI (DMD)
Entity Type:Individual
Prefix:
First Name:BOSHI
Middle Name:
Last Name:ZHANG
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 1:10 ABBEY HALL
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-5967
Mailing Address - Country:US
Mailing Address - Phone:847-691-5313
Mailing Address - Fax:
Practice Address - Street 1:200 W 2ND ST STE 109
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07060-1218
Practice Address - Country:US
Practice Address - Phone:908-755-3030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027564001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics