Provider Demographics
NPI:1518108133
Name:BOEDIGHEIMER, JOHN KENNEDY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:KENNEDY
Last Name:BOEDIGHEIMER
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 1:1445 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:OH
Mailing Address - Zip Code:45365-1782
Mailing Address - Country:US
Mailing Address - Phone:937-492-9983
Mailing Address - Fax:937-492-8869
Practice Address - Street 1:1445 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-1782
Practice Address - Country:US
Practice Address - Phone:937-492-9983
Practice Address - Fax:937-492-8869
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH014422122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist