Provider Demographics
NPI:1730211764
Name:BOULE, MELVIN ANTHONY (DMD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:ANTHONY
Last Name:BOULE
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 1:1879 ASTER DR
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-5806
Mailing Address - Country:US
Mailing Address - Phone:630-553-2816
Mailing Address - Fax:
Practice Address - Street 1:3910 TURNER AVE
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:IL
Practice Address - Zip Code:60545-9727
Practice Address - Country:US
Practice Address - Phone:630-552-3410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice