Individual
DR. MIRETTE BOUSHRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
19815 GOVERNORS HWY STE 7, FLOSSMOOR, IL 60422
(708) 794-4253
Mailing address
19815 GOVERNORS HWY STE 7, FLOSSMOOR, IL 60422-4388
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019032069
IL
Other
Enumeration date
07/12/2019
Last updated
08/10/2019
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