Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 0024578 | TX |
Y | 1223X0400X | Orthodontists | 24578 | TX |
NPI | 1013244987 |
---|---|
Provider Name | Dr. Reann Boss |
First Address | Kyle, TX 78640-2475 |
Second Address | Kyle, TX 78640-2475 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2009 |
Last Update Date | 03/08/2021 |