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General NPI Number Information
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NPI Number | 1063572261
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Entity Type | Organization
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Legal Business Name | BOERO & PIERI DDS A DENTAL CORPORATION
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 908 E STREET
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City | SAN RAFAEL
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State | CA
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Zip | 94901
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Country | US
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Telephone | 415-454-8640
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Fax | 415-457-3241
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Provider Business Mailing Address
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Address Line | 908 E STREET
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City | SAN RAFAEL
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State | CA
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Zip | 94901
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Country | US
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Telephone | 415-454-8640
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Fax | 415-457-3241
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Authorized Official
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Title or Position | OWNER
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Name | DR. GARY G BOERO
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Credential | DDS
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Telephone | 415-454-8640
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 18450
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 219797
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License Number State | CA
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