Provider Demographics
NPI:1285849463
Name:BOHMAN, BRIAN CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:CHRISTOPHER
Last Name:BOHMAN
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 1:14144 SUN BLAZE LOOP
Mailing Address - Street 2:UNIT D
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4555
Mailing Address - Country:US
Mailing Address - Phone:702-245-0723
Mailing Address - Fax:
Practice Address - Street 1:13605 XAVIER LN
Practice Address - Street 2:SUITE D
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80023-3603
Practice Address - Country:US
Practice Address - Phone:720-887-8357
Practice Address - Fax:720-887-8359
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2009-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO95991223X0400X
NV50551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics