Healthcare Provider Details

I. General information

NPI: 1013535731
Provider Name (Legal Business Name): BRITTANY BOOMGARDEN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 US HIGHWAY 51
MCFARLAND WI
53558-8708
US

IV. Provider business mailing address

5914 GREEN CLOVER LN
FITCHBURG WI
53711-5123
US

V. Phone/Fax

Practice location:
  • Phone: 608-716-8622
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019032777
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1002479-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: