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General NPI Number Information
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NPI Number | 1326246778
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Entity Type | Individual
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Provider Name | JONATHAN EDMUND BOES D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 01/07/2016
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Provider Practice Location Address
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Address Line | 3415 ROGERS RD. SUITE 100
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City | WAKE FOREST
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State | NC
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Zip | 27587
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Country | US
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Telephone | 919-554-9955
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Fax | 919-554-9933
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Provider Business Mailing Address
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Address Line | 8470 FALLS OF NEUSE RD. SUITE 202
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City | RALEIGH
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State | NC
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Zip | 27615
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Country | US
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Telephone | 919-977-0627
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Fax | 919-977-4079
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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 | 8432
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8432
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License Number State | NC
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