Provider Demographics
NPI:1871848697
Name:BOEHM, EMILY ANNE (DDS)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANNE
Last Name:BOEHM
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 1:9000 CINCINNATI DAYTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-3103
Mailing Address - Country:US
Mailing Address - Phone:513-755-2118
Mailing Address - Fax:513-755-5732
Practice Address - Street 1:9000 CINCINNATI DAYTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3103
Practice Address - Country:US
Practice Address - Phone:513-755-2118
Practice Address - Fax:513-755-5732
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist