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General NPI Number Information
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NPI Number | 1821349366
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Entity Type | Individual
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Provider Name | MEENAKSHI BOSE DDS
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Gender | Female
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Dates
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Enumeration Date | 09/24/2012
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Last Update Date | 06/21/2013
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Provider Practice Location Address
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Address Line | 6428 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20012-2910
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Country | US
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Telephone | 518-567-9875
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Fax |
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Provider Business Mailing Address
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Address Line | 2448 SUGAR MILL WAY
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City | HERNDON
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State | VA
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Zip | 20171-3069
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Country | US
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Telephone | 518-567-9875
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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 | 0401413778
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License Number State | VA
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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 | DEN1001161
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License Number State | DC
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