Provider Demographics
NPI:1851500888
Name:DANIEL A. BOSTON DDS, PC
Entity Type:Organization
Organization Name:DANIEL A. BOSTON DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:AGEE
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-752-3343
Mailing Address - Street 1:1320 N 600 E
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341-2431
Mailing Address - Country:US
Mailing Address - Phone:435-752-3343
Mailing Address - Fax:435-787-1825
Practice Address - Street 1:1320 N 600 E
Practice Address - Street 2:SUITE 1
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341-2431
Practice Address - Country:US
Practice Address - Phone:435-752-3343
Practice Address - Fax:435-787-1825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137627-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty