Individual
ANTHONY WALTER BOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1880 W WAYZATA BLVD, LONG LAKE, MN 55356-9491
(952) 475-0989
(952) 475-2053
Mailing address
1880 W WAYZATA BLVD, P O BOX 128, LONG LAKE, MN 55356-9491
(952) 475-0989
(952) 475-2053
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D8481
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
91D71B0
BLUE CROSS BLUE SHIELD ID
MN
01
—
D8481
MN BOARD OF DENTISTRY #
MN
Enumeration date
11/16/2006
Last updated
07/08/2007
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