Provider Demographics
NPI:1467620195
Name:BOHL, ERIC W (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:BOHL
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 1:1024 E SCHAUMBURG RD
Mailing Address - Street 2:
Mailing Address - City:STREAMWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60107-1874
Mailing Address - Country:US
Mailing Address - Phone:630-837-7775
Mailing Address - Fax:630-837-6440
Practice Address - Street 1:1024 E SCHAUMBURG
Practice Address - Street 2:
Practice Address - City:STREAMWOOD
Practice Address - State:IL
Practice Address - Zip Code:60107-1874
Practice Address - Country:US
Practice Address - Phone:630-837-7775
Practice Address - Fax:630-837-6440
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190187101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice