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General NPI Number Information
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NPI Number | 1801913405
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Entity Type | Organization
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Legal Business Name | MARC R BOIVIN DDS LLC
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4181 LOUGHBOROUGH AVE
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City | ST LOUIS
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State | MO
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Zip | 63116
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Country | US
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Telephone | 314-832-2628
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Fax | 314-832-2637
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Provider Business Mailing Address
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Address Line | 4181 LOUGHBOROUGH AVE
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City | ST LOUIS
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State | MO
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Zip | 63116
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Country | US
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Telephone | 314-832-2628
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Fax | 314-832-2637
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MARC ROBERT BOIVIN
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Credential | DDS
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Telephone | 314-832-2628
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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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