Elise M Boncher, DDS
Dentist, General Practice in Grand Rapids, MI. Individual provider (NPI-1).
NPI number1457504151
StatusActive
Last updated in NPPESJun 8, 2009
Details
- NPI
- 1457504151
- Entity type
- Individual (NPI-1)
- Name
- Elise M Boncher
- Credential
- DDS
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 28, 2008
- Last updated
- Jun 8, 2009
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 2901019968 | MI | Yes |
| 1223G0001X | Dentist, General Practice | 4539 | SC |
Practice location
550 Cherry St SeCherry Street Health Services - Dental
Grand Rapids, MI 49503-4748
Phone 616-235-7289
Mailing address
550 Cherry St SeCherry Street Health Services - Dental
Grand Rapids, MI 49503-4748
Phone 616-235-7289
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