BOULEVARD DENTAL CLINIC
NPI: 1639346182
· FAIRFAX, VA 22031
· Dental Clinic/Center
· NPI assigned 05/14/2008
$519.09
Total Medicaid Paid
Provider Details
| Authorized Official | GAITAN, RICARDO (GENERAL DENTIST) |
| NPI Enumeration Date | 05/14/2008 |
Related Entities
Other providers sharing the same authorized official: GAITAN, RICARDO
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2022 |
12 |
$519.09 |
| 2023 |
12 |
$0.00 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
24 |
24 |
$519.09 |