Provider Demographics
NPI:1275634057
Name:BOHAKER, TIMOTHY DWIGHT (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DWIGHT
Last Name:BOHAKER
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 1:200 MARYLAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-1925
Mailing Address - Country:US
Mailing Address - Phone:410-228-9177
Mailing Address - Fax:410-221-1754
Practice Address - Street 1:200 MARYLAND AVENUE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1925
Practice Address - Country:US
Practice Address - Phone:410-228-9177
Practice Address - Fax:410-221-1754
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5177122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist