Provider Demographics
NPI:1679739437
Name:BOHL, ROSS FRANK (DMD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:FRANK
Last Name:BOHL
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 1:740 S EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4635
Mailing Address - Country:US
Mailing Address - Phone:815-337-9622
Mailing Address - Fax:815-338-1250
Practice Address - Street 1:740 S EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-4635
Practice Address - Country:US
Practice Address - Phone:815-337-9622
Practice Address - Fax:815-338-1250
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-022875122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist