Provider Demographics
NPI:1033189113
Name:BOEHMER, MONICA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:BOEHMER
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 1:3309 JUAN TABO BLVD NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-5131
Mailing Address - Country:US
Mailing Address - Phone:505-271-8009
Mailing Address - Fax:505-271-8009
Practice Address - Street 1:3309 JUAN TABO BLVD NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-5131
Practice Address - Country:US
Practice Address - Phone:505-271-8009
Practice Address - Fax:505-271-8009
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM16771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice