Provider Demographics
NPI:1073664538
Name:DRS KARL & CHARLES BOESTER INC.
Entity Type:Organization
Organization Name:DRS KARL & CHARLES BOESTER INC.
Other - Org Name:DR. CHARLES H. BOESTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:BOESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:216-741-3854
Mailing Address - Street 1:5252 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1630
Mailing Address - Country:US
Mailing Address - Phone:216-741-3854
Mailing Address - Fax:
Practice Address - Street 1:5252 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1630
Practice Address - Country:US
Practice Address - Phone:216-741-3854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty