Mandy Kay-Marie Boese, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6001206-15 Issued in WI

Practice address

1507 Tower Ave Ste 410
Superior, WI 54880-2562

Phone

(715) 392-6213

NPI assigned

Jun 22, 2023

Last updated

Jun 22, 2023By the provider in NPPES

Sex

Female

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

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

• Nbo Dental, LLC

  • Dental Clinic/Center
  • Superior, WI
  • NPI 1689378333
  NPD
• Neal B O'Shaughnessy DDS LTD

  • General Practice Dentistry
  • Superior, WI
  • NPI 1871679035
  NPD (past)

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

{
    "created_epoch": "1687392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687392000000",
    "number": "1730865122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1023 CENTRAL AVE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548806224",
            "telephone_number": "715-513-0240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 TOWER AVE STE 410",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548802562",
            "telephone_number": "715-392-6213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOESE",
        "first_name": "MANDY",
        "middle_name": "KAY-MARIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-06-22",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6001206-15",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Ann Bergstedt, PHARM.D.
• Sylvia Margaret Bevis
• Bio-Medical Applications of Wisconsin, Inc. (FMC Dialysis Services Superior)
• Paula Bjoralt, OTR
• Alisha Marie Bliss, CSAC, LADC
• Kaylee K Bovard
• Katherine Frances Bradley, MA, CCC-SLP
• Vicki Brady, APRN
• Jason C. Bramstedt, DC
• Gwendolyn Marie Brand, RN, APNP

• General Practice Dentistry in Superior, WI
• Providers in Superior, 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 Jun 22, 2023; 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.