Mark Boeche, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3112 Issued in WI

Practice address

1915 E Milwaukee St
Janesville, WI 53545-2647

Phone

(608) 754-5768

Fax

(608) 754-7195

NPI assigned

Aug 5, 2008

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dr. Mark Boeche D.D.S. Inc.

  • General Practice Dentistry
  • Janesville, WI
  • NPI 1235140013
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1217894400000",
    "number": "1063678407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1915 E MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535452647",
            "telephone_number": "608-754-5768",
            "fax_number": "608-754-7195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 E MILWAUKEE ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535452647",
            "telephone_number": "608-754-5768",
            "fax_number": "608-754-7195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOECHE",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-05",
        "last_updated": "2008-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "3112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33471100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dan Blaser
• Leah Blazkovec, OTR
• Bloom Therapy and Wellness, LLC
• Diana M. Bloomberg, LICENSED PRACTICAL N
• Jonathan Daniel Boarini, DDS
• Kathleen M. Boertman, OT
• Mark C Boettcher, MD
• Michele Renee Bohland, PTA
• Kristine Ann Bohrmueller, ARNP
• Macy G Bolt, PT

• General Practice Dentistry in Janesville, WI
• Providers in Janesville, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.