Provider Demographics
NPI:1518059682
Name:BOETTCHER, THOMAS HOWE (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:HOWE
Last Name:BOETTCHER
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 1:1441 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3420
Mailing Address - Country:US
Mailing Address - Phone:847-433-3038
Mailing Address - Fax:847-433-8736
Practice Address - Street 1:185 MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3010
Practice Address - Country:US
Practice Address - Phone:847-634-3848
Practice Address - Fax:847-634-2338
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice