Provider Demographics
NPI:1235162603
Name:SOIFER, BOHAN B (DMD)
Entity Type:Individual
Prefix:
First Name:BOHAN
Middle Name:B
Last Name:SOIFER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822-1408
Mailing Address - Country:US
Mailing Address - Phone:518-654-6640
Mailing Address - Fax:518-654-2155
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-1408
Practice Address - Country:US
Practice Address - Phone:518-654-6640
Practice Address - Fax:518-654-2155
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0299681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice