Provider Demographics
NPI:1619070141
Name:BOEHM, DANA RAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:RAY
Last Name:BOEHM
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 1:8220 LOUETTA ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379
Mailing Address - Country:US
Mailing Address - Phone:281-370-5088
Mailing Address - Fax:281-370-0303
Practice Address - Street 1:8220 LOUETTA RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:281-370-5088
Practice Address - Fax:281-370-0303
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist