Daniel Richard Boettcher, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

6001804-15 Issued in WI

Practice address

2111 W Wisconsin Ave Apt 17
Milwaukee, WI 53233-1936

Phone

(920) 376-1478

NPI assigned

May 28, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Interoperability endpoints

• Direct secure messaging: dboettcher997307@direct.vumc.org

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

{
    "created_epoch": "1748390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1748390400000",
    "number": "1104619303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 W WISCONSIN AVE APT 17",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532331936",
            "telephone_number": "920-376-1478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 W WISCONSIN AVE APT 17",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532331936",
            "telephone_number": "920-376-1478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTCHER",
        "first_name": "DANIEL",
        "middle_name": "RICHARD",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-05-28",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6001804-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brice Remi Boembeke
• Timothy Frederic Boerger, PHD, ATC
• Abigail Rose Boesel, PA-C
• Carol Anne Boesel, PT
• Brent Thomas Boettcher
• Michelle Boettcher, RDH
• Noelle Boettcher, SLP C.C.
• Samantha Rose Boettcher
• Max Boettner, ATC, LAT
• Thomas Boffeli

• Dentist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2025; 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.