Provider Demographics
NPI:1285906925
Name:BOSTIAN, ROBERTA ANN (RDHAP)
Entity type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:ANN
Last Name:BOSTIAN
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17331 VAILETTI DR
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-3344
Mailing Address - Country:US
Mailing Address - Phone:707-695-2495
Mailing Address - Fax:
Practice Address - Street 1:17331 VAILETTI DR
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-3344
Practice Address - Country:US
Practice Address - Phone:707-695-2495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA387124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist