Healthcare Provider Details

I. General information

NPI: 1265495899
Provider Name (Legal Business Name): DANIEL ALLEN BOEDIGHEIMER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 MAIN STREET
HAWLEY MN
56549-0849
US

IV. Provider business mailing address

PO BOX 849 520 MAIN ST.
HAWLEY MN
56549-0849
US

V. Phone/Fax

Practice location:
  • Phone: 218-483-1038
  • Fax: 218-483-1339
Mailing address:
  • Phone: 218-483-1038
  • Fax: 218-483-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD7290
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: