Provider Demographics
NPI:1124783188
Name:BOETTNER, HELEN
Entity type:Individual
Prefix:
First Name:HELEN
Middle Name:
Last Name:BOETTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1565 HOLLENBECK AVE STE 116
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4394
Mailing Address - Country:US
Mailing Address - Phone:408-736-6856
Mailing Address - Fax:
Practice Address - Street 1:1565 HOLLENBECK AVE STE 116
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4394
Practice Address - Country:US
Practice Address - Phone:408-736-6856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant