MEDICARE: DR. VICTORIA ROSE BOVARD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS043716	PA

General Provider Information

NPI Number	:	1609500289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTORIA ROSE BOVARD DDS

Provider Business Mailing Address
First Line	:	2015 WILMINGTON RD
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1928
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 WILMINGTON RD
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16105-1928
Country	:	US
Telephone Number	:	724-658-1681
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2022
Last Update Date	:	07/11/2022

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