Provider Demographics
NPI:1255493193
Name:BOHAY, IHOR (DDS)
Entity Type:Individual
Prefix:
First Name:IHOR
Middle Name:
Last Name:BOHAY
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 1:29500 RYAN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48092
Mailing Address - Country:US
Mailing Address - Phone:586-574-3050
Mailing Address - Fax:
Practice Address - Street 1:29500 RYAN RD
Practice Address - Street 2:C
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092
Practice Address - Country:US
Practice Address - Phone:586-574-3050
Practice Address - Fax:586-574-3051
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901012457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist