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General NPI Number Information
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NPI Number | 1518690635
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Entity Type | Organization
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Legal Business Name | JANE BOESCHENSTEIN DDS PC
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Dates
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Enumeration Date | 07/06/2022
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Last Update Date | 07/28/2022
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Provider Practice Location Address
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Address Line | 657 BALDWIN ST
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City | JENISON
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State | MI
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Zip | 49428-7903
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Country | US
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Telephone | 616-532-3212
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Fax |
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Provider Business Mailing Address
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Address Line | 657 BALDWIN ST
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City | JENISON
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State | MI
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Zip | 49428-7903
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Country | US
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Telephone | 616-532-3212
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Fax |
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Authorized Official
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Title or Position | DENTIST / OWNER
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Name | JANE BOESCHENSTEIN
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Credential |
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Telephone | 616-532-3212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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