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General NPI Number Information
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NPI Number | 1881031409
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Entity Type | Organization
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Legal Business Name | RICHARD A BOONE DDS INC
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Dates
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Enumeration Date | 05/23/2013
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Last Update Date | 05/23/2013
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Provider Practice Location Address
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Address Line | 8715 EL CAMINO REAL
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City | ATASCADERO
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State | CA
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Zip | 93422
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Country | US
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Telephone | 805-466-6998
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Fax | 805-466-5833
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Provider Business Mailing Address
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Address Line | 8715 EL CAMINO REAL
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City | ATASCADERO
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State | CA
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Zip | 93422
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Country | US
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Telephone | 805-466-6998
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD A BOONE
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Credential |
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Telephone | 805-466-6998
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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 | 34062
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License Number State | CA
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