Boettcher, Mark R
Boettcher, Mark R is an individual health care provider with primary practice located at 16905 West Wisconsin Ave , Brookfield WI 53005-5729. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Boettcher, Mark R can be contacted via phone (262) 754-4480.Contact Information
Primary practice address
16905 West Wisconsin Ave
Brookfield WI 53005-5729
Phone: (262) 754-4480
Fax: (262) 754-4470
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 5001903015 | Wisconsin |
Profile Details
| NPI number | 1083826390 |
|---|---|
| LBN Legal business name | Boettcher, Mark R |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 7th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083826390 | NPPES |
| Wisconsin | MEDICAID | 33363900 |
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