MEDICARE: LIVET BOFFIL DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26205	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003487745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIVET BOFFIL DMD

Provider Business Mailing Address
First Line	:	10540 NW 78TH ST APT 5-410
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-6079
Country	:	US
Telephone Number	:	305-798-4583
Fax Number	:

Provider Business Practice Location Address
First Line	:	10540 NW 78TH ST APT 5-410
Second Line	:
City	:	DORAL
State	:	FL
Zip	:	33178-6079
Country	:	US
Telephone Number	:	305-798-4583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2021
Last Update Date	:	07/04/2021

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Directions to “ LIVET BOFFIL DMD” Practice Location

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