NPI 1023308392

Boulos Dental Care, P.C.

Organisation Exclusive Provider Organization Shoreview, MN

Practice location

Address: 470 Highway 96 W Suite 200, Shoreview, MN 55126-1996
Phone: (952) 465-7210
Mailing address: 110 Carlson Pkwy APT #115, Minnetonka, MN 55305-5334

Authorised official

Name: Samy Wasfy Yousef Boulos
Title: Dentist (DDS)
Phone: (952) 465-7210

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 12329 (MN)

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Registry record

NPI: 1023308392
Entity type: Organization
NPI issued: 7 Apr 2011
Record last updated: 7 Apr 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.