Healthcare Provider Details

I. General information

NPI: 1861397028
Provider Name (Legal Business Name): DR. ANDREW STEPHEN BOSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3165 MOUNT PLEASANT ST NW
WASHINGTON DC
20010-2709
US

IV. Provider business mailing address

1110 FIDLER LN APT 1623
SILVER SPRING MD
20910-3464
US

V. Phone/Fax

Practice location:
  • Phone: 202-462-1925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN2001730
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: