Provider Demographics
NPI:1992364368
Name:BOSEY DENTAL ENTERPRISES PLLC
Entity Type:Organization
Organization Name:BOSEY DENTAL ENTERPRISES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CODY
Authorized Official - Middle Name:
Authorized Official - Last Name:BOSEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-278-0840
Mailing Address - Street 1:4698 S HIGHLAND DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-5265
Mailing Address - Country:US
Mailing Address - Phone:801-278-0840
Mailing Address - Fax:
Practice Address - Street 1:4698 S HIGHLAND DR STE 200
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-5265
Practice Address - Country:US
Practice Address - Phone:801-278-0840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-10
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty