Provider Demographics
NPI:1528155025
Name:BOONE, DAVID A (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:BOONE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 E BELTLINE AVE NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-4598
Mailing Address - Country:US
Mailing Address - Phone:616-361-6161
Mailing Address - Fax:616-361-8016
Practice Address - Street 1:1525 E BELTLINE AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-4598
Practice Address - Country:US
Practice Address - Phone:616-361-6161
Practice Address - Fax:616-361-8016
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017780122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist