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Organization
KELLEN AND RAMONA BOSMA DMD PC
Active
Organization
KELLEN AND RAMONA BOSMA DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLEN BOSMA D.M.D. (PRESIDENT)
(815) 758-5045
Entity
Organization
Contact information
Practice address
2600 DEKALB AVE, SUITE D, SYCAMORE, IL 60178-3131
(815) 758-5045
Mailing address
2600 DEKALB AVE, SUITE D, SYCAMORE, IL 60178-3131
(815) 758-5045
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019029540
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043676443
NPI TYPE I FOR DR. RAMONA BOSMA
IL
01
—
1407288830
NPI TYPE I
IL
Enumeration date
08/05/2015
Last updated
08/05/2015
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