Provider Demographics
NPI:1790575959
Name:BOSCH, VICTORIA (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:BOSCH
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S SEA LAKE LN
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4752
Mailing Address - Country:US
Mailing Address - Phone:904-403-6715
Mailing Address - Fax:
Practice Address - Street 1:9450 E MISSISSIPPI AVE UNIT A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80247-2427
Practice Address - Country:US
Practice Address - Phone:720-463-2766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-10
Last Update Date:2025-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000000000001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice