Provider Demographics
NPI:1811879182
Name:BOULEVARD DENTAL BELLEAIR LLC
Entity type:Organization
Organization Name:BOULEVARD DENTAL BELLEAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:WUJICK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-262-5220
Mailing Address - Street 1:1016 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:BELLEAIR
Mailing Address - State:FL
Mailing Address - Zip Code:33756-1073
Mailing Address - Country:US
Mailing Address - Phone:727-393-6024
Mailing Address - Fax:727-489-2831
Practice Address - Street 1:1016 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:BELLEAIR
Practice Address - State:FL
Practice Address - Zip Code:33756-1073
Practice Address - Country:US
Practice Address - Phone:727-393-6024
Practice Address - Fax:727-489-2831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty