Provider Demographics
NPI:1154568228
Name:BOSIO, JOSE A (BDS, MS)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:BOSIO
Suffix:
Gender:M
Credentials:BDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3319 BURTON DR
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1359
Mailing Address - Country:US
Mailing Address - Phone:414-324-9591
Mailing Address - Fax:
Practice Address - Street 1:650 W BALTIMORE ST # 3221
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1510
Practice Address - Country:US
Practice Address - Phone:410-706-2974
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLL8221223X0400X
WI209-8751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics