Provider Demographics
NPI:1043476443
Name:BOSMA, RAMONA GEORGETA (DMD)
Entity type:Individual
Prefix:DR
First Name:RAMONA
Middle Name:GEORGETA
Last Name:BOSMA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13035 OLIVE BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-6173
Mailing Address - Country:US
Mailing Address - Phone:314-205-0111
Mailing Address - Fax:
Practice Address - Street 1:13035 OLIVE BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6173
Practice Address - Country:US
Practice Address - Phone:314-205-0111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008023543122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist