Provider Demographics
NPI:1023197910
Name:KAREN M. BOETTCHER, D.D.S.,S.C.
Entity Type:Organization
Organization Name:KAREN M. BOETTCHER, D.D.S.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BOETTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-246-6806
Mailing Address - Street 1:P O BOX 229
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:WI
Mailing Address - Zip Code:53089-0229
Mailing Address - Country:US
Mailing Address - Phone:262-246-6806
Mailing Address - Fax:262-246-6892
Practice Address - Street 1:N63 W23401 MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:WI
Practice Address - Zip Code:53089-0229
Practice Address - Country:US
Practice Address - Phone:262-246-6806
Practice Address - Fax:262-246-6892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
35913OtherAETNA
1455326OtherUNITED CONCORDIA