Healthcare Provider Details

I. General information

NPI: 1730270364
Provider Name (Legal Business Name): ANN Y. BOU D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1995 ROUTE 17M
GOSHEN NY
10924-5231
US

IV. Provider business mailing address

1995 ROUTE 17M
GOSHEN NY
10924-5231
US

V. Phone/Fax

Practice location:
  • Phone: 845-294-8089
  • Fax: 845-294-3859
Mailing address:
  • Phone: 845-294-8089
  • Fax: 845-294-3859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number049881-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: