Provider Demographics
NPI:1639222383
Name:BOSKOVIC, MILOS M (DDS)
Entity Type:Individual
Prefix:
First Name:MILOS
Middle Name:M
Last Name:BOSKOVIC
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13372 NEWPORT AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3426
Mailing Address - Country:US
Mailing Address - Phone:714-832-2672
Mailing Address - Fax:714-832-1607
Practice Address - Street 1:13372 NEWPORT AVE
Practice Address - Street 2:SUITE G
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3426
Practice Address - Country:US
Practice Address - Phone:714-832-2672
Practice Address - Fax:714-832-1607
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312101223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics