Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 2398 | ND |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 16610 | ND |
NPI | 1588962781 |
---|---|
Provider Name | Dr. William J Boggess |
First Address | Sioux Falls, SD 57117-5074 |
Second Address | Fargo, ND 58103-4939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2011 |
Last Update Date | 19/10/2021 |