Juanita Valles Boettcher, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D8455 Issued in OR

Practice address

8615 SE 11TH Ave
Portland, OR 97202-7011

Phone

(503) 516-1291

NPI assigned

Jul 26, 2006

Last updated

Mar 25, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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 OR

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kaiser Dental

  • Dental Assistant
  • Portland, OR
  • NPI 1003965922
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742860800000",
    "number": "1689697005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8615 SE 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027011",
            "telephone_number": "503-516-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8615 SE 11TH AVE",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972027011",
            "telephone_number": "503-516-1291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTCHER",
        "first_name": "JUANITA",
        "middle_name": "VALLES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D8455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Boeres
• Heidi R Boersma, O.D.
• Jason Boeshans
• Michelle Boeshans
• Jodie Lynn Boettcher
• Lynette Michelle Boettger, LPN
• Pui Yi Boey, FRCSED
• Melinda Kaye Boffing, OTD
• Nika Saba Bogaert, LCSW
• Courtney Marie Bogart

• General Practice Dentistry in Portland, OR
• Providers in Portland, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 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.