Individual
DR. MARK R BOETTCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16905 WEST WISCONSIN AVE, BROOKFIELD, WI 53005-5729
(262) 754-4480
(262) 754-4470
Mailing address
16905 WEST WISCONSIN AVE, BROOKFIELD, WI 53005-5729
(262) 754-4480
(262) 754-4470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
5001903015
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33363900
—
WI
Enumeration date
05/07/2007
Last updated
07/08/2007
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