Provider Demographics
NPI:1427187764
Name:BOS, BERNARD DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:DEAN
Last Name:BOS
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 1:14805 SE MONNER RD
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-5806
Mailing Address - Country:US
Mailing Address - Phone:503-784-2471
Mailing Address - Fax:
Practice Address - Street 1:19230 MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2625
Practice Address - Country:US
Practice Address - Phone:503-656-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD71281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice