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General NPI Number Information
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NPI Number | 1487839619
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Entity Type | Individual
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Provider Name | BO G HA D.D.S
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Gender | Female
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 900 MERCHANTS CONCOURSE SUITE LL8
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City | WESTBURY
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State | NY
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Zip | 11590-5142
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Country | US
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Telephone | 516-683-9100
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Fax | 516-683-1232
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Provider Business Mailing Address
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Address Line | 234 PRAIRIE DR
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City | NORTH BABYLON
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State | NY
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Zip | 11703-1002
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Country | US
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Telephone | 631-338-0118
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 051606
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License Number State | NY
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