Provider Demographics
NPI:1073635793
Name:BOVA, ANTHONY VINCENT (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VINCENT
Last Name:BOVA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 A PRINCE STREET
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02113
Mailing Address - Country:US
Mailing Address - Phone:617-523-4446
Mailing Address - Fax:617-523-3275
Practice Address - Street 1:79 A PRINCE STREET
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02113
Practice Address - Country:US
Practice Address - Phone:617-523-4446
Practice Address - Fax:617-523-3275
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist