MEDICARE: DR. PATRICIA FERNANDES BOETTNER DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D13422	MN
2	1223X2210X	Orofacial Pain Dentistry	D13422	MN
3	122300000X	Dentist	FL34	MN
4	261QM1300X	Multi-Specialty Clinic/Center	D13422	MN

General Provider Information

NPI Number	:	1700153368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PATRICIA FERNANDES BOETTNER DDS, MS

Provider Business Mailing Address
First Line	:	2200 COUNTY ROAD C W STE 2210
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-2551
Country	:	US
Telephone Number	:	651-746-2815
Fax Number	:

Provider Business Practice Location Address
First Line	:	1835 COUNTY ROAD C W STE 200
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-1353
Country	:	US
Telephone Number	:	651-636-2016
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	02/09/2026

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