Provider Demographics
NPI:1699859181
Name:BOST, THOMAS LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:LEE
Last Name:BOST
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 1:126 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16125-2166
Mailing Address - Country:US
Mailing Address - Phone:724-588-3012
Mailing Address - Fax:724-588-0922
Practice Address - Street 1:126 COLLEGE AVENUE
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2166
Practice Address - Country:US
Practice Address - Phone:724-588-3012
Practice Address - Fax:724-588-0922
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020826L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005223370001Medicaid
PA3127OtherUNITED CONCORDIA