MEDICARE: DR. KIRK L BOETTCHER D.D.S.

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	1223G0001X	General Practice Dentistry	4903	WA

General Provider Information

NPI Number	:	1720169410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK L BOETTCHER D.D.S.

Provider Business Mailing Address
First Line	:	12600 SE 38TH ST
Second Line	:	#204
City	:	BELLEVUE
State	:	WA
Zip	:	98006-6105
Country	:	US
Telephone Number	:	425-747-6640
Fax Number	:

Provider Business Practice Location Address
First Line	:	12600 SE 38TH ST
Second Line	:	#204
City	:	BELLEVUE
State	:	WA
Zip	:	98006-6105
Country	:	US
Telephone Number	:	425-747-6640
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	06/11/2012

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