Provider Demographics
NPI:1134296015
Name:BOISETTE, PASCAL (DDS)
Entity type:Individual
Prefix:
First Name:PASCAL
Middle Name:
Last Name:BOISETTE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:361 EASTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4103
Mailing Address - Country:US
Mailing Address - Phone:718-756-4193
Mailing Address - Fax:718-735-3670
Practice Address - Street 1:361 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4103
Practice Address - Country:US
Practice Address - Phone:718-756-4193
Practice Address - Fax:718-735-3670
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0481821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2776385Medicaid