Organization
BOULOS DENTAL CARE, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SAMY WASFY YOUSEF BOULOS (DENTIST (DDS))
(952) 465-7210
Entity
Organization
Contact information
Practice address
470 HIGHWAY 96 W, SUITE 200, SHOREVIEW, MN 55126-1996
(952) 465-7210
Mailing address
110 CARLSON PKWY, APT #115, MINNETONKA, MN 55305-5334
(952) 465-7210
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
12329
MN
Other
Enumeration date
04/07/2011
Last updated
04/07/2011
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