Provider Demographics
NPI:1891852943
Name:BOERS, CHAD
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:
Last Name:BOERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 ELM ST APT 118
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4733
Mailing Address - Country:US
Mailing Address - Phone:715-219-1030
Mailing Address - Fax:
Practice Address - Street 1:227071 HUMMINGBIRD RD
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3332
Practice Address - Country:US
Practice Address - Phone:715-845-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC116351223G0001X
WI60131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice