Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 2901020630 | MI |
NPI | 1073878070 |
---|---|
Provider Name | Brandon David Boike |
First Address | Naples, FL 34112-8424 |
Second Address | Naples, FL 34113-8976 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2012 |
Last Update Date | 01/07/2014 |