Provider Demographics
NPI:1881023315
Name:BOSZKO, TRINITY ELISE (DMD)
Entity Type:Individual
Prefix:
First Name:TRINITY
Middle Name:ELISE
Last Name:BOSZKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 E SUNRISE BLVD UNIT 512
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2871
Mailing Address - Country:US
Mailing Address - Phone:314-221-6832
Mailing Address - Fax:
Practice Address - Street 1:7319 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32818-6746
Practice Address - Country:US
Practice Address - Phone:407-294-9200
Practice Address - Fax:407-294-1577
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-05
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN204231223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics