Provider Demographics
NPI:1902064579
Name:BOSCAMP, CLINTON ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:ROBERT
Last Name:BOSCAMP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9880 S RURAL RD STE 108
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-4118
Mailing Address - Country:US
Mailing Address - Phone:480-940-5422
Mailing Address - Fax:480-940-5515
Practice Address - Street 1:9880 S RURAL RD STE 108
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-4118
Practice Address - Country:US
Practice Address - Phone:480-940-5422
Practice Address - Fax:480-940-5515
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice