MEDICARE: MINETTE MARIE GALURA-BOQUIREN RDH

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	124Q00000X	Dental Hygienist	102189	NV

General Provider Information

NPI Number	:	1942892419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINETTE MARIE GALURA-BOQUIREN RDH

Provider Business Mailing Address
First Line	:	3237 GRAYSON LAKE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6614
Country	:	US
Telephone Number	:	702-672-3284
Fax Number	:

Provider Business Practice Location Address
First Line	:	3237 GRAYSON LAKE CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6614
Country	:	US
Telephone Number	:	702-672-3284
Fax Number	:

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

Provider Enumeration Date	:	02/06/2021
Last Update Date	:	02/06/2021

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