Healthcare Provider Details

I. General information

NPI: 1073878070
Provider Name (Legal Business Name): BRANDON DAVID BOIKE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2012
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 E 8TH ST
TRAVERSE CITY MI
49686-2955
US

IV. Provider business mailing address

4983 SHAKER HEIGHTS CT APT 202
NAPLES FL
34112-8424
US

V. Phone/Fax

Practice location:
  • Phone: 231-947-4566
  • Fax:
Mailing address:
  • Phone: 810-845-6758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901020630
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: