Provider Demographics
NPI:1306497680
Name:BITA KHOSHROU DMD OF BOYNTON PA
Entity type:Organization
Organization Name:BITA KHOSHROU DMD OF BOYNTON PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOSHROU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:817-715-9658
Mailing Address - Street 1:1010 BEAR ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-2011
Mailing Address - Country:US
Mailing Address - Phone:817-715-9658
Mailing Address - Fax:
Practice Address - Street 1:374 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-3414
Practice Address - Country:US
Practice Address - Phone:817-715-9658
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty