MEDICARE: DR. JOSEPH BOFFA DDS, MPH

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	122300000X	Dentist	12679	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X05017	OTHER	MA	BLUECROSSBLUESHIELD

General Provider Information

NPI Number	:	1770624306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH BOFFA DDS, MPH

Provider Business Mailing Address
First Line	:	459 UNDERWOOD ST
Second Line	:
City	:	HOLLISTON
State	:	MA
Zip	:	01746-1510
Country	:	US
Telephone Number	:	508-429-1789
Fax Number	:

Provider Business Practice Location Address
First Line	:	459 UNDERWOOD ST
Second Line	:
City	:	HOLLISTON
State	:	MA
Zip	:	01746-1510
Country	:	US
Telephone Number	:	508-429-1789
Fax Number	:

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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