Provider Demographics
NPI:1982247938
Name:BERNARD D BOS DDS INC
Entity Type:Organization
Organization Name:BERNARD D BOS DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-784-2471
Mailing Address - Street 1:19230 MCLOUGHLIN BLVD
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2625
Mailing Address - Country:US
Mailing Address - Phone:503-656-1208
Mailing Address - Fax:503-722-1822
Practice Address - Street 1:19230 MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2625
Practice Address - Country:US
Practice Address - Phone:503-656-1208
Practice Address - Fax:503-722-1822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental