| Boulevard Dental Llc | |
|
8475 Seminole Blvd Seminole FL 33772-4329 | |
| (727) 393-6025 | |
| (727) 397-5222 |
| Full Name | Boulevard Dental Llc |
|---|---|
| Speciality | Dentist |
| Location | 8475 Seminole Blvd, Seminole, Florida |
| Authorized Official Name and Position | Frank B Moss (OWNER) |
| Authorized Official Contact | 7273936024 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Boulevard Dental Llc 8475 Seminole Blvd Seminole FL 33772-4329 Ph: (727) 393-6025 | Boulevard Dental Llc 8475 Seminole Blvd Seminole FL 33772-4329 Ph: (727) 393-6025 |
| NPI Number | 1114073590 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114073590 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | DN6079 (Florida) | Primary |
| 122300000X | Dentist | DN16886 (Florida) | Secondary |
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