Provider Demographics
NPI:1770624306
Name:BOFFA, JOSEPH (DDS, MPH)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:BOFFA
Suffix:
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 UNDERWOOD ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-1510
Mailing Address - Country:US
Mailing Address - Phone:508-429-1789
Mailing Address - Fax:
Practice Address - Street 1:459 UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:HOLLISTON
Practice Address - State:MA
Practice Address - Zip Code:01746-1510
Practice Address - Country:US
Practice Address - Phone:508-429-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12679122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX05017OtherBLUECROSSBLUESHIELD