Individual
KELLEN BOSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
125 W COLUMBIAN BLVD S, LITCHFIELD, IL 62056-3021
(217) 324-2610
Mailing address
125 W COLUMBIAN BLVD S, LITCHFIELD, IL 62056-3021
(217) 324-2610
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019.029540
IL
Other
Enumeration date
08/08/2013
Last updated
08/08/2013
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