Provider Demographics
NPI:1477530442
Name:BOHME, RICHARD KURT ALEXANDER (DDS, FAGD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:KURT ALEXANDER
Last Name:BOHME
Suffix:
Gender:M
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 W SIEBENTHALER AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45405-1860
Mailing Address - Country:US
Mailing Address - Phone:937-275-8521
Mailing Address - Fax:937-275-7578
Practice Address - Street 1:545 W SIEBENTHALER AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45405-1860
Practice Address - Country:US
Practice Address - Phone:937-275-8521
Practice Address - Fax:937-275-7578
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH195151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice