Provider Demographics
NPI:1013308279
Name:BOSTON, DANIEL WARD
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:WARD
Last Name:BOSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:BOSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:421 SAINT DAVIDS RD
Mailing Address - Street 2:
Mailing Address - City:ST DAVIDS
Mailing Address - State:PA
Mailing Address - Zip Code:19087-4309
Mailing Address - Country:US
Mailing Address - Phone:610-254-8495
Mailing Address - Fax:
Practice Address - Street 1:3223 NORTH BROAD STREET
Practice Address - Street 2:TEMPLE UNIVERSITY KORNBERG SCHOOL OF DENTISTRY
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5007
Practice Address - Country:US
Practice Address - Phone:215-707-2979
Practice Address - Fax:215-707-7616
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026584L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist