DR. MIRETTE BOUSHRA (NPI# 1306498035) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306498035 |
| Entity Type | Individual |
| Full Name | DR. MIRETTE BOUSHRA |
| Credential | DMD |
| Practice Address |
19815 Governors Hwy Ste 7 Flossmoor IL 60422 |
| Mailing Address |
19815 Governors Hwy Ste 7 Flossmoor IL 60422-4388 |
| Practice Telephone | 7087944253 |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-08-10 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 019032069 | IL | Dental Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 18610 Burnham Ave Ste D, Lansing, IL 604383500 | 7088950778 |
| Street Address |
19815 GOVERNORS HWY STE 7 |
| City | FLOSSMOOR |
| State | IL |
| Zip Code | 60422 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568991040 | Ni Van | Dentist | 19815 Governors Hwy Ste 7, Flossmoor, IL 60422-4388 | 2017-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588274310 | Miranda Home Health Care Inc | Nursing Care | 19150 S. Kedzie Ave, 203, Flossmoor, IL 60422 | 2020-08-06 |
| 1285256172 | Bp Behavioral Services, LLC | Behavioral Analyst | 2222 Marston Lane, Flossmoor, IL 60422 | 2020-05-13 |
| 1891164133 | Lauren Simpson | Behavioral Analyst | 19530 Kezie Avenue, Flossmoor, IL 60422 | 2015-09-16 |
| 1437541190 | Keshawn Gardner | Specialist/Technologist, Other | 1248 Berry Ln, Flossmoor, IL 60422 | 2015-03-04 |
| 1770989717 | Naomi Kelly | Behavioral Analyst | 1930 Kedzie Avenue, Flossmoor, IL 60422 | 2014-11-18 |
| 1093059453 | Miranda Home Health Care Inc | In Home Supportive Care | 19150 S Kedzie Ave, 203, Flossmoor, IL 60422 | 2012-11-23 |
| 1285981506 | Restorative Life Services, LLC | Social Worker | 169624 Governors Highway, Flossmoor, IL 60422 | 2012-08-06 |
| 1063786457 | Gwyneeda Carter-sidberry | Pharmacist | 1443 Selkirk Street, Flossmoor, IL 60422 | 2012-03-02 |
| 1053682021 | Alfonso Javier Medina Sr. | Anesthesiology | 3141 Stonegate Ct., Flossmoor, IL 60422 | 2012-01-23 |
| 1912121161 | Anthony J Maoloni | Dentist | 19815 Governors Highway, Orthodontic Associates Ltd Suite 1, Flossmoor, IL 60422 | 2007-04-12 |
| Find all providers in zip 60422 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356492276 | Carmella B Perry | Dentist | 2711 Flossmoor Rd, Flossmoor, IL 60422-1141 | 2007-01-16 |
| 1811076722 | Beth Ann Jarosik | Dentist | 2630 Flossmoor Rd, Suite 103, Flossmoor, IL 60422-1546 | 2006-11-02 |
| 1063515401 | Lester C Liby | Dentist | 19730 1 Governors Hwy, Flossmoor, IL 60422 | 2006-09-07 |
| 1164820544 | Generand Carandang Algenio | Dentist | 19815 Governors Hwy, Suite 4, Flossmoor, IL 60422-4385 | 2014-12-16 |
| 1891107371 | Tru Dental Illinois, P.C. | Dentist | 19509 Governors Hwy, Flossmoor, IL 60422-2097 | 2014-06-02 |
| 1497175988 | Performace Dental Care Il PC | Dentist | 19509 Governors Hwy, Flossmoor, IL 60422-2097 | 2014-04-23 |
| 1649427246 | Judy Ann Johnson | Dentist | 1030 Sterling Ave, Flossmoor, IL 60422-1265 | 2008-08-26 |
| 1639325293 | The Center for Dental Excellence, LLC | Dentist | 19615 Governors Hwy, Flossmoor, IL 60422-2037 | 2008-08-14 |
| 1336288695 | Southland Smiles, Ltd | Dentist | 19815 Governors Hwy, Suite 7, Flossmoor, IL 60422-4385 | 2007-02-05 |
| 1063561231 | Barbara Lynn Malone | Dentist | 19615 Governors Hwy, Flossmoor, IL 60422 | 2007-01-09 |
| Find all providers in FLOSSMOOR | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.