Mark R Boettcher DDS

NPI 1083826390 - Dentist - 1223G0001X

NPI Details
NPI 1083826390
Gender Male
Enumeration Date 05/07/2007
Last Updated 07/08/2007
Entity Type Individual
Active Over 9 years ago
Practice Location
16905 WEST WISCONSIN AVE
BROOKFIELD WI, 53005-5729, US
Phone (262) 754-4480
Fax (262) 754-4470
Business Location
16905 WEST WISCONSIN AVE
BROOKFIELD WI, 53005-5729, US
Phone (262) 754-4480
Fax (262) 754-4470
Toxanomy
Taxonomy Code 1223G0001X
License State Wisconsin
License Number 5001903015
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According to our database, Dr. Mark R Boettcher DDS NPI is 1083826390, taxonomy code is 1223G0001X and license number is 5001903015, license state is located at Wisconsin. Mark R Boettcher DDS physically located at 16905 West Wisconsin Ave, Brookfield WI, 53005-5729. NPI Number Mark R Boettcher DDS has the Individual type.

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1083826390 NPI number is provided on an as is basis without warranty of any kind. 1083826390 is maintained by the National Plan & Provider Enumeration System. The contents of Mark R Boettcher DDS are for informational purposes only.