Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 019030677 | IL |
NPI | 1003265273 |
---|---|
Provider Name | Dr. Katherine Boente |
First Address | Carlinville, IL 62626-1951 |
Second Address | Carlinville, IL 62626-1951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2016 |
Last Update Date | 08/06/2016 |