Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 48088 | CA |
NPI | 1063584019 |
---|---|
Provider Name | Dr. David Rossi Boschken |
First Address | San Jose, CA 95119-1432 |
Second Address | San Jose, CA 95119-1432 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2006 |
Last Update Date | 08/07/2007 |