Daniel R Boettcher, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

4609 Issued in WI

Practice address

1503 Randolph CT
Manitowoc, WI 54220-8345

Phone

(920) 682-0321

Fax

(920) 682-3128

NPI assigned

Aug 23, 2005

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

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.

• Dental Park SC

  • Dental Clinic/Center
  • Manitowoc, WI
  • NPI 1386636959
  NPD (past) Authorized official

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1801889043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1503 RANDOLPH CT",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542208345",
            "telephone_number": "920-682-0321",
            "fax_number": "920-682-3128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1503 RANDOLPH CT",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542208345",
            "telephone_number": "920-682-0321",
            "fax_number": "920-682-3128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOETTCHER",
        "first_name": "DANIEL",
        "middle_name": "R",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "4609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33727300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Krishna Bhatt, M.D.
• Bio-Medical Applications of Wisconsin, Inc.
• Craig Bishop
• Sheana Blackmon
• Blue Waters Family Counseling, S.C.
• Julia A Boldt, PTA
• Shannon Marie Bolick
• Lori A Bonin, PT
• Michael Bonin
• Nicole Bonin, MSW, LCSW

• All providers in Manitowoc, WI
• Dentist in Wisconsin

• 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.
• 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.