Provider Demographics
NPI:1013154806
Name:BOSS DENTAL, PLC
Entity type:Organization
Organization Name:BOSS DENTAL, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:BOSS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-331-3868
Mailing Address - Street 1:905 E. PICKARD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT. PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858
Mailing Address - Country:US
Mailing Address - Phone:989-775-3336
Mailing Address - Fax:989-773-4042
Practice Address - Street 1:905 E. PICKARD
Practice Address - Street 2:SUITE A
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-775-3336
Practice Address - Fax:989-773-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty