Provider Demographics
NPI:1386703262
Name:BOAIN DENTAL CARE
Entity type:Organization
Organization Name:BOAIN DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOAIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:314-921-3527
Mailing Address - Street 1:1001 DUNN RD
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-8215
Mailing Address - Country:US
Mailing Address - Phone:314-921-3527
Mailing Address - Fax:
Practice Address - Street 1:1001 DUNN RD
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8215
Practice Address - Country:US
Practice Address - Phone:314-921-3527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty