Organization
KELLEN AND RAMONA BOSMA DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KELLEN BOSMA D.M.D. (PRESIDENT)
(815) 758-5045
Entity
Organization
Contact information
Practice address
2600 DEKALB AVE, SUITE D, SYCAMORE, IL 60178-3131
(815) 758-5045
Mailing address
2600 DEKALB AVE, SUITE D, SYCAMORE, IL 60178-3131
(815) 758-5045
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
019029540
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043676443
NPI TYPE I FOR DR. RAMONA BOSMA
IL
01
—
1407288830
NPI TYPE I
IL
Enumeration date
08/05/2015
Last updated
08/05/2015
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