Provider Demographics
NPI:1629174651
Name:BOHATCH, GREGORY ANDREW (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ANDREW
Last Name:BOHATCH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 LONG RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15235-4330
Mailing Address - Country:US
Mailing Address - Phone:412-241-1888
Mailing Address - Fax:412-241-2057
Practice Address - Street 1:509 LONG RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4330
Practice Address - Country:US
Practice Address - Phone:412-241-1888
Practice Address - Fax:412-241-2057
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027408L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice