Provider Demographics
NPI:1437171493
Name:BOEHLER, ANGELA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MARIE
Last Name:BOEHLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17912 TOLEDO BLADE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1021
Mailing Address - Country:US
Mailing Address - Phone:941-625-5141
Mailing Address - Fax:941-625-5001
Practice Address - Street 1:17912 TOLEDO BLADE BLVD STE B
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1021
Practice Address - Country:US
Practice Address - Phone:941-625-5141
Practice Address - Fax:941-625-5001
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN-14715122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist