Provider Demographics
NPI:1225056757
Name:BOEHLE, WILLIAM HENRY (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:HENRY
Last Name:BOEHLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 PORTOLA DR
Mailing Address - Street 2:STE 103
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1234
Mailing Address - Country:US
Mailing Address - Phone:415-731-7700
Mailing Address - Fax:415-731-1065
Practice Address - Street 1:801 PORTOLA DR
Practice Address - Street 2:STE 103
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127-1234
Practice Address - Country:US
Practice Address - Phone:415-731-7700
Practice Address - Fax:415-731-1065
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25237122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist