Provider Demographics
NPI:1013563303
Name:BOHR, KATHLEEN JO (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:JO
Last Name:BOHR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 SUNSET
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:IA
Mailing Address - Zip Code:50643-2224
Mailing Address - Country:US
Mailing Address - Phone:563-203-0447
Mailing Address - Fax:
Practice Address - Street 1:3308 KIMBALL AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-5758
Practice Address - Country:US
Practice Address - Phone:319-233-6177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-097001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice