Provider Demographics
NPI:1801800131
Name:BOEDING, BARB (DDS)
Entity type:Individual
Prefix:
First Name:BARB
Middle Name:
Last Name:BOEDING
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:IA
Mailing Address - Zip Code:50659-1455
Mailing Address - Country:US
Mailing Address - Phone:641-394-3016
Mailing Address - Fax:641-394-4819
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:IA
Practice Address - Zip Code:50659-1455
Practice Address - Country:US
Practice Address - Phone:641-394-3016
Practice Address - Fax:641-394-4819
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA07307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA26352OtherBLUE CROSS BLUE SHIELD
IA1048082Medicaid
IA835364OtherUNITED CONCORDIA