MEDICARE: DR. EDWARD JOSEPH BOOS D.D.S.

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	2577	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A2654	OTHER	LA	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1902960677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD JOSEPH BOOS D.D.S.

Provider Business Mailing Address
First Line	:	3100 GALLERIA DR STE 202
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-2196
Country	:	US
Telephone Number	:	504-456-5033
Fax Number	:	504-456-5057

Provider Business Practice Location Address
First Line	:	3100 GALLERIA DR STE 202
Second Line	:
City	:	METAIRIE
State	:	LA
Zip	:	70001-2196
Country	:	US
Telephone Number	:	504-456-5033
Fax Number	:	504-456-5057

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	10/15/2018

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Directions to “ DR. EDWARD JOSEPH BOOS D.D.S.” Practice Location

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