Stuart William Boekeloo, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

14693 Issued in MI

Practice address

2525 S Cleveland Ave
Saint Joseph, MI 49085-2609

Phone

(269) 429-6101

Fax

(269) 429-7029

NPI assigned

Apr 23, 2007

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Stuart Boekeloo, DDS, PC

  • Dental Clinic/Center
  • Saint Joseph, MI
  • NPI 1629712062
  NPD Authorized official

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1356569602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 S CLEVELAND AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852609",
            "telephone_number": "269-429-6101",
            "fax_number": "269-429-7029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 S CLEVELAND AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852609",
            "telephone_number": "269-429-6101",
            "fax_number": "269-429-7029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEKELOO",
        "first_name": "STUART",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "14693",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE NUMBER",
            "identifier": "14693",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Margaret L Bluhm, LMSW
• Juliana Marie Bluschke, DC
• Jensen Hope Boardman, CHW
• Body Logic Alternative Therapies, Inc.
• Spencer Ryan Boehm, DO
• Jay Richard Bond
• Blanka Bono
• Eva M Borcherding, LMT
• Frederick William Born, D.O.
• Daniel Davis Bosis Jr., M.D.

• General Practice Dentistry in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.