Provider Demographics
NPI:1235469529
Name:BOEHM, TOBIAS KONRAD (DDS, PHD)
Entity Type:Individual
Prefix:DR
First Name:TOBIAS
Middle Name:KONRAD
Last Name:BOEHM
Suffix:
Gender:M
Credentials:DDS, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E SECOND ST
Mailing Address - Street 2:COLLEGE OF DENTAL MEDICINE / WESTERN UNIVERSITY
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1854
Mailing Address - Country:US
Mailing Address - Phone:909-706-3831
Mailing Address - Fax:909-706-3800
Practice Address - Street 1:795 E SECOND STREET
Practice Address - Street 2:SUITE 8
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3910
Practice Address - Fax:909-469-8650
Is Sole Proprietor?:No
Enumeration Date:2010-01-08
Last Update Date:2018-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA598071223P0300X
NY053283-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics