Provider Demographics
NPI:1801913405
Name:MARC R BOIVIN DDS LLC
Entity type:Organization
Organization Name:MARC R BOIVIN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:BOIVIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-832-2628
Mailing Address - Street 1:4181 LOUGHBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63116
Mailing Address - Country:US
Mailing Address - Phone:314-832-2628
Mailing Address - Fax:314-832-2637
Practice Address - Street 1:4181 LOUGHBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63116
Practice Address - Country:US
Practice Address - Phone:314-832-2628
Practice Address - Fax:314-832-2637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty