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Organization

BOSTON DENTAL OF WI LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
BRIAN BOSTON (OWNER)
(920) 892-6961
Entity
Organization

Contact information

Practice address
3064 S BUSINESS DR, SHEBOYGAN, WI 53081-6522
(920) 892-6961
Mailing address
PO BOX 3189, SYRACUSE, NY 13220-3189

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary

Other

Enumeration date
12/06/2017
Last updated
12/06/2017
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