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General NPI Number Information
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NPI Number | 1033380357
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Entity Type | Individual
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Provider Name | JANE ELIZABETH BOESCHENSTEIN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 3040 PRAIRIE ST SW
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City | GRANDVILLE
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State | MI
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Zip | 49418-2046
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Country | US
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Telephone | 616-532-3212
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Fax | 616-532-3193
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Provider Business Mailing Address
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Address Line | PO BOX 6363
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City | GRAND RAPIDS
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State | MI
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Zip | 49516-6363
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Country | US
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Telephone | 616-532-3212
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Fax | 616-532-3193
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901017729
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License Number State | MI
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