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General NPI Number Information
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NPI Number | 1801010467
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Entity Type | Organization
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Legal Business Name | NEW CREATION DENTAL CARE, L.C.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 15 LAKESIDE DR STE A
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1378
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Country | US
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Telephone | 636-625-1225
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Fax |
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Provider Business Mailing Address
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Address Line | 15 LAKESIDE DR STE A
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City | LAKE ST LOUIS
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State | MO
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Zip | 63367-1378
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Country | US
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Telephone | 636-625-1225
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW BOSCIA
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Credential | D.M.D.
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Telephone | 636-625-1225
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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 | 2003013106
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License Number State | MO
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