Organization
DR CHRIS BOSEOVSKI DMD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MEGAN CONVILLE BACH IN PSYCH (MANAGER)
(570) 622-0386
Entity
Organization
Contact information
Practice address
1349 W MARKET ST, POTTSVILLE, PA 17901-2282
(570) 622-0386
(570) 622-0484
Mailing address
PO 1019, POTTSVILLE, PA 17901
(570) 622-0386
(570) 622-0484
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS035206
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018864420002
—
PA
01
—
1181283
GATEWAY
PA
01
—
1589307
UNITED CONCORDIA
PA
01
—
158984
UNISON
PW
01
—
174855
CIGNA
PA
01
—
215153
CIGNA
PA
01
—
838906
AETNA
PA
01
—
871884
AETNA
PA
Enumeration date
10/26/2006
Last updated
08/22/2020
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