Provider Demographics
NPI:1801575485
Name:BOSKUS, JULIANNA (DDS)
Entity type:Individual
Prefix:
First Name:JULIANNA
Middle Name:
Last Name:BOSKUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 OLD GREENSBORO RD BLDG B
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-0003
Mailing Address - Country:US
Mailing Address - Phone:870-336-5620
Mailing Address - Fax:
Practice Address - Street 1:255 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-3903
Practice Address - Country:US
Practice Address - Phone:870-225-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR46931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice