Provider Demographics
NPI:1285795070
Name:LEE R. BOESE, D.D.S., M.S.D., INC.
Entity type:Organization
Organization Name:LEE R. BOESE, D.D.S., M.S.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:BOESE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:209-723-3776
Mailing Address - Street 1:177 W EL PORTAL DR
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2833
Mailing Address - Country:US
Mailing Address - Phone:209-723-3776
Mailing Address - Fax:
Practice Address - Street 1:177 W EL PORTAL DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2833
Practice Address - Country:US
Practice Address - Phone:209-723-3776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty