Individual
SHIRLEY BOOTZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDH
Contact information
Practice address
220 DEAN JOHNSON BLVD, SOUTH BEND, IN 46601-3415
(574) 289-7001
(574) 236-7166
Mailing address
220 DEAN JOHNSON BLVD, SOUTH BEND, IN 46601-3415
(574) 289-7001
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
13004216A
IN
Other
Enumeration date
12/13/2021
Last updated
12/13/2021
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