Provider Demographics
NPI:1619754892
Name:BOSCARILLO, FRANK (DMD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:
Last Name:BOSCARILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1499 WINDHORST WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-8800
Mailing Address - Country:US
Mailing Address - Phone:317-452-4361
Mailing Address - Fax:
Practice Address - Street 1:3791 S.R. 63
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036
Practice Address - Country:US
Practice Address - Phone:317-452-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-12
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.027728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist