Provider Demographics
NPI:1326246778
Name:BOES, JONATHAN EDMUND (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:EDMUND
Last Name:BOES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 FALLS OF NEUSE RD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-977-0627
Mailing Address - Fax:919-977-4079
Practice Address - Street 1:3415 ROGERS RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-554-9955
Practice Address - Fax:919-554-9933
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8432122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist