=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932902822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BOS DENTAL PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/28/2025
-----------------------------------------------------
Last Update Date | 03/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7063 MESSER RD
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23231-5509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-222-3310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7063 MESSER RD
-----------------------------------------------------
City | HENRICO
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23231-5509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-222-3310
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BEHNAZ MOVAHED
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 804-938-5450
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------