Boettcher, Daniel R
Boettcher, Daniel R is an individual health care provider with primary practice located at 1503 Randolph Ct , Manitowoc WI 54220-8345. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Boettcher, Daniel R can be contacted via phone (920) 682-0321.Contact Information
Primary practice address
1503 Randolph Ct
Manitowoc WI 54220-8345
Phone: (920) 682-0321
Fax: (920) 682-3128
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 4609 | Wisconsin |
Profile Details
| NPI number | 1801889043 |
|---|---|
| LBN Legal business name | Boettcher, Daniel R |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 23rd, 2005 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801889043 | NPPES |
| Wisconsin | MEDICAID | 33727300 |
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