Provider Demographics
NPI:1679599138
Name:BOCA PARK DENTAL INC
Entity Type:Organization
Organization Name:BOCA PARK DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-240-6200
Mailing Address - Street 1:1000 S RAMPART BLVD
Mailing Address - Street 2:STE 13
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-8531
Mailing Address - Country:US
Mailing Address - Phone:702-240-6200
Mailing Address - Fax:702-952-8118
Practice Address - Street 1:1000 S RAMPART BLVD
Practice Address - Street 2:STE 13
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-8531
Practice Address - Country:US
Practice Address - Phone:702-240-6200
Practice Address - Fax:702-952-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6375090001Medicare NSC