Provider Demographics
NPI:1225871023
Name:BOSS, TARGHEE (DDS)
Entity type:Individual
Prefix:
First Name:TARGHEE
Middle Name:
Last Name:BOSS
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 1:351 COLMAR STREET
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-4704
Mailing Address - Country:US
Mailing Address - Phone:912-435-9185
Mailing Address - Fax:
Practice Address - Street 1:351 W 6TH STREET
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-4704
Practice Address - Country:US
Practice Address - Phone:912-435-9185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14091394-9923122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist