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General NPI Number Information
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NPI Number | 1326124728
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Entity Type | Individual
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Provider Name | ALICE G BOGHOSIAN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2006
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Last Update Date | 10/26/2023
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Provider Practice Location Address
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Address Line | 101 S WASHINGTON AVE SUITE 135
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City | PARK RIDGE
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State | IL
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Zip | 60068-4200
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Country | US
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Telephone | 847-692-7760
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Fax | 847-692-2264
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Provider Business Mailing Address
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Address Line | 324 WAUKEGAN RD
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City | GLENVIEW
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State | IL
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Zip | 60025-5161
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Country | US
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Telephone | 847-692-7760
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Fax | 847-730-3020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019019583
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License Number State | IL
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