Individual
DR. MATTHEW JAMES BOSCIA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
15 LAKESIDE DR, LAKE ST LOUIS, MO 63367-1378
(636) 625-1225
(636) 625-1228
Mailing address
15 LAKESIDE DR STE A, LAKE ST LOUIS, MO 63367-1378
(636) 625-1225
(636) 625-1228
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2003013106
MO
332B00000X
Durable Medical Equipment & Medical Supplies
2003013106
MO
Other
Enumeration date
01/05/2010
Last updated
12/04/2018
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