Healthcare Provider Details

I. General information

NPI: 1639222383
Provider Name (Legal Business Name): MILOS M. BOSKOVIC DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13372 NEWPORT AVE SUITE G
TUSTIN CA
92780-3426
US

IV. Provider business mailing address

13372 NEWPORT AVE SUITE G
TUSTIN CA
92780-3426
US

V. Phone/Fax

Practice location:
  • Phone: 714-832-2672
  • Fax: 714-832-1607
Mailing address:
  • Phone: 714-832-2672
  • Fax: 714-832-1607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number31210
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: