Provider Demographics
NPI:1033380357
Name:BOESCHENSTEIN, JANE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ELIZABETH
Last Name:BOESCHENSTEIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6363
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49516-6363
Mailing Address - Country:US
Mailing Address - Phone:616-532-3212
Mailing Address - Fax:616-532-3193
Practice Address - Street 1:3040 PRAIRIE ST SW
Practice Address - Street 2:
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2046
Practice Address - Country:US
Practice Address - Phone:616-532-3212
Practice Address - Fax:616-532-3193
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017729122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist