Provider Demographics
NPI:1922155696
Name:BOE, IRWIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRWIN
Middle Name:
Last Name:BOE
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 1:13430 W 62ND TER
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1784
Mailing Address - Country:US
Mailing Address - Phone:913-962-4400
Mailing Address - Fax:913-962-1144
Practice Address - Street 1:13430 W 62ND TER
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216-1784
Practice Address - Country:US
Practice Address - Phone:913-962-4400
Practice Address - Fax:913-962-1144
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS603031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice