Paul John Bosco, DMD
Individual provider Active NPI Dentist · Newport, VT
NPI 1720097447 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1720097447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- Practice address
- 494 Highland Ave
Newport, VT 05855 - Phone
- (802) 334-1400
- Fax
- (802) 334-1809
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000000653 | VT | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vermont Family Dental PLC | Past |
Accepting new patients | |
| Newport Family Dental, PLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | VT | Yes |
Addresses
Primary practice location
494 Highland Ave
Newport, VT 05855
Mailing address
68 Tamarack Rd
Jay, VT 05859
Phone (802) 988-4357
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0001953 | Medicaid | VT |
Other providers in Newport, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.