Provider Demographics
NPI:1700153368
Name:BOETTNER, PATRICIA FERNANDES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:FERNANDES
Last Name:BOETTNER
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:FERNANDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS, MS
Mailing Address - Street 1:2200 COUNTY ROAD C W STE 2210
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-2551
Mailing Address - Country:US
Mailing Address - Phone:651-746-2815
Mailing Address - Fax:
Practice Address - Street 1:1835 COUNTY ROAD C W STE 200
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1353
Practice Address - Country:US
Practice Address - Phone:651-636-2016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNFL34122300000X
MND13422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist