Provider Demographics
NPI:1184827446
Name:DR DANIEL BOEH DMD PSC
Entity Type:Organization
Organization Name:DR DANIEL BOEH DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:GARDNER
Authorized Official - Last Name:BOEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-554-1324
Mailing Address - Street 1:100 FOUNTAIN AVE
Mailing Address - Street 2:SUITE #314
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001
Mailing Address - Country:US
Mailing Address - Phone:270-444-6032
Mailing Address - Fax:270-444-7843
Practice Address - Street 1:100 FOUNTAIN AVE
Practice Address - Street 2:SUITE #314
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001
Practice Address - Country:US
Practice Address - Phone:270-444-6032
Practice Address - Fax:270-444-7843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3752122300000X
KY222122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty