MEDICARE: JANE BOESCHENSTEIN DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1518690635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JANE BOESCHENSTEIN DDS PC

Provider Business Mailing Address
First Line	:	657 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7903
Country	:	US
Telephone Number	:	616-532-3212
Fax Number	:

Provider Business Practice Location Address
First Line	:	657 BALDWIN ST
Second Line	:
City	:	JENISON
State	:	MI
Zip	:	49428-7903
Country	:	US
Telephone Number	:	616-532-3212
Fax Number	:

Authorized Official
Title or Position	:	DENTIST / OWNER
Name	:	JANE BOESCHENSTEIN
Credential	:
Telephone Number	:	616-532-3212

Provider Enumeration Date	:	07/06/2022
Last Update Date	:	07/28/2022

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