Individual
DR. SAMY WASFY BOULOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
470 HIGHWAY 96 W STE 200, SHOREVIEW, MN 55126-3214
(651) 366-6880
(651) 366-6881
Mailing address
470 HIGHWAY 96 W STE 200, SHOREVIEW, MN 55126-3214
(651) 366-6880
(651) 366-6881
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12329
MN
Other
Enumeration date
04/03/2009
Last updated
02/14/2019
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