Healthcare Provider Details

I. General information

NPI: 1366952368
Provider Name (Legal Business Name): HOLAHAN & BOE ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2017
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1013 HUDSON ROAD
CEDAR FALLS IA
50613
US

IV. Provider business mailing address

3905 WEDGEWOOD DR
CEDAR FALLS IA
50613-6011
US

V. Phone/Fax

Practice location:
  • Phone: 503-332-8338
  • Fax:
Mailing address:
  • Phone: 503-332-8338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LUCAS SIDNEY BOE
Title or Position: ORTHODONTIST
Credential: DMD
Phone: 503-332-8338