Healthcare Provider Details

I. General information

NPI: 1942833512
Provider Name (Legal Business Name): CHRISTINA BOESCH, DMD, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2020
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5155 S JOHN YOUNG PKWY
ORLANDO FL
32839-5021
US

IV. Provider business mailing address

5155 S JOHN YOUNG PKWY
ORLANDO FL
32839-5021
US

V. Phone/Fax

Practice location:
  • Phone: 407-928-2806
  • Fax:
Mailing address:
  • Phone: 407-928-2806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINA BOESCH
Title or Position: OWNER
Credential: DMD, MAGD
Phone: 407-857-0950