Provider Demographics
NPI:1538303243
Name:BOHLE, GREGORY CHARLES (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CHARLES
Last Name:BOHLE
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARK TREE RD
Mailing Address - Street 2:
Mailing Address - City:CENTEREACH
Mailing Address - State:NY
Mailing Address - Zip Code:11720-2279
Mailing Address - Country:US
Mailing Address - Phone:631-737-2626
Mailing Address - Fax:631-673-6299
Practice Address - Street 1:1 MARK TREE RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-2279
Practice Address - Country:US
Practice Address - Phone:631-737-2626
Practice Address - Fax:631-673-6299
Is Sole Proprietor?:No
Enumeration Date:2009-04-24
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0556101223S0112X
NYPENDING1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery