Provider Demographics
NPI:1760157937
Name:BOSON, ALEX JENNINGS (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JENNINGS
Last Name:BOSON
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 1:830 SHENANDOAH DR UNIT B285
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-5133
Mailing Address - Country:US
Mailing Address - Phone:715-305-5099
Mailing Address - Fax:
Practice Address - Street 1:136 MAIN ST W
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-2334
Practice Address - Country:US
Practice Address - Phone:952-758-3003
Practice Address - Fax:952-758-1939
Is Sole Proprietor?:No
Enumeration Date:2021-08-10
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND146491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice