Individual
TARGHEE BOSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
351 W 6TH STREET, FORT STEWART, GA 31314-4704
(912) 435-9185
Mailing address
351 COLMAR STREET, FORT STEWART, GA 31314-4704
(912) 435-9185
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14091394-9923
UT
Other
Enumeration date
06/18/2024
Last updated
08/14/2024
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