Provider Demographics
NPI:1942892419
Name:GALURA-BOQUIREN, MINETTE MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:MINETTE
Middle Name:MARIE
Last Name:GALURA-BOQUIREN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3237 GRAYSON LAKE CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6614
Mailing Address - Country:US
Mailing Address - Phone:702-672-3284
Mailing Address - Fax:
Practice Address - Street 1:3237 GRAYSON LAKE CT
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-6614
Practice Address - Country:US
Practice Address - Phone:702-672-3284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-06
Last Update Date:2021-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV102189124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist