Individual
DR. DANIEL E BOEDEKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
527 W PLATTE AVE, FORT MORGAN, CO 80701-2654
(970) 867-4477
(970) 867-4499
Mailing address
527 W PLATTE AVE, FORT MORGAN, CO 80701-2654
(970) 867-4477
(970) 867-4499
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
10147
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
274452081
TAX ID
CO
Enumeration date
04/25/2006
Last updated
10/18/2011
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