Provider Demographics
NPI:1437558103
Name:BOEHM, AUSTIN F (DMD)
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:F
Last Name:BOEHM
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 1:6706 EVERCREST LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-1819
Mailing Address - Country:US
Mailing Address - Phone:315-525-4580
Mailing Address - Fax:
Practice Address - Street 1:3401 ROYAL VISTA BLVD STE A-100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-1149
Practice Address - Country:US
Practice Address - Phone:512-909-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-19
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX379751223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist