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General NPI Number Information
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NPI Number | 1306497680
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Entity Type | Organization
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Legal Business Name | BITA KHOSHROU DMD OF BOYNTON PA
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Dates
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Enumeration Date | 09/26/2019
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Last Update Date | 09/26/2019
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Provider Practice Location Address
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Address Line | 374 N CONGRESS AVE
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City | BOYNTON BEACH
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State | FL
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Zip | 33426-3414
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Country | US
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Telephone | 817-715-9658
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 BEAR ISLAND DR
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City | WEST PALM BEACH
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State | FL
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Zip | 33409-2011
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Country | US
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Telephone | 817-715-9658
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. BITA KHOSHROU
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Credential | DMD
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Telephone | 817-715-9658
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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 |
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License Number State |
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