Provider Demographics
NPI:1700967031
Name:BOENTE, STEVEN JOHN (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOHN
Last Name:BOENTE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OAKLAND AVE
Mailing Address - Street 2:
Mailing Address - City:CARLINVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62626-1951
Mailing Address - Country:US
Mailing Address - Phone:217-854-4741
Mailing Address - Fax:217-854-6505
Practice Address - Street 1:204 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:CARLINVILLE
Practice Address - State:IL
Practice Address - Zip Code:62626-1951
Practice Address - Country:US
Practice Address - Phone:217-854-4741
Practice Address - Fax:217-854-6505
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190185551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-4680991OtherFEDERAL TAX ID #