Organization
BOSS DENTAL
Active
Parent organization
BOSS DENTAL
Organization subpart
Yes
Provider details
NPI number
Legal business name
BOSS DENTAL
Authorized official
ANGELA LO (DENTIST)
(718) 567-8283
Entity
Organization
Contact information
Practice address
612 60TH ST, BROOKLYN, NY 11220-4101
(718) 567-8283
Mailing address
612 60TH ST, BROOKLYN, NY 11220-4101
(718) 567-8283
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
047068
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02618188
—
NY
Enumeration date
08/01/2006
Last updated
03/27/2013
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