Provider Demographics
NPI:1598078206
Name:BOHM, CARRIE LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYNN
Last Name:BOHM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:698 BEAR RIDGE DR NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5605
Mailing Address - Country:US
Mailing Address - Phone:206-790-5526
Mailing Address - Fax:
Practice Address - Street 1:698 BEAR RIDGE DR NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5605
Practice Address - Country:US
Practice Address - Phone:206-790-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-22
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA594731223G0001X
WADE601595661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice