Provider Demographics
NPI:1467839126
Name:BOULOS, TOUFIC (DMD)
Entity type:Individual
Prefix:
First Name:TOUFIC
Middle Name:
Last Name:BOULOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PLACE DE LA COTE VERTU APT 1009
Mailing Address - Street 2:
Mailing Address - City:ST LAURENT
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:H4N1G4
Mailing Address - Country:CA
Mailing Address - Phone:514-833-9388
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 210TH STREET
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467
Practice Address - Country:US
Practice Address - Phone:718-920-4321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-01
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program