Individual
DR. LISA MICHELLE BOSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
55682 STATE HIGHWAY 6 STE D, EDINA, MO 63537-4268
(660) 397-2213
(660) 397-3929
Mailing address
55682 STATE HIGHWAY 6 STE D, EDINA, MO 63537-4268
(660) 397-2213
(660) 397-3929
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2019019283
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2019019283
DENTIST
MO
Enumeration date
06/14/2019
Last updated
07/25/2024
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