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General NPI Number Information
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NPI Number | 1437401619
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Entity Type | Individual
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Provider Name | TARA BROOKE BOSHNACK DDS
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Gender | Female
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 4955 S DURANGO DR 201
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City | LAS VEGAS
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State | NV
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Zip | 89113
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Country | US
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Telephone | 702-933-7275
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Fax |
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Provider Business Mailing Address
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Address Line | 2866 LOVELAND DR UNIT 2036
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City | LAS VEGAS
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State | NV
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Zip | 89109-0227
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Country | US
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Telephone | 516-509-5031
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 6271
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License Number State | NV
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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 | DN19585
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 056092
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License Number State | NY
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