Provider Demographics
NPI:1851897854
Name:BOSSOLINA DDS PLLC
Entity Type:Organization
Organization Name:BOSSOLINA DDS PLLC
Other - Org Name:CENTER CITY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BOSSOLINA
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-979-4323
Mailing Address - Street 1:400 SOUTH TRYON STREET
Mailing Address - Street 2:SUITE M-4
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202
Mailing Address - Country:US
Mailing Address - Phone:704-376-5950
Mailing Address - Fax:
Practice Address - Street 1:400 SOUTH TRYON STREET
Practice Address - Street 2:SUITE M-4
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202
Practice Address - Country:US
Practice Address - Phone:704-376-5950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-30
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10133261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013205368OtherPERSONAL, NOT BUSINESS NPI