Provider Demographics
NPI:1013077239
Name:BOHANNAN, WILLIAM B (DDS, MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:BOHANNAN
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Gender:M
Credentials:DDS, MD
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Mailing Address - Street 1:1750 EL CAMINO REAL
Mailing Address - Street 2:SUITE 403
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010
Mailing Address - Country:US
Mailing Address - Phone:650-692-1530
Mailing Address - Fax:650-692-2655
Practice Address - Street 1:1750 EL CAMINO REAL
Practice Address - Street 2:SUITE 403
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3228
Practice Address - Country:US
Practice Address - Phone:650-692-1530
Practice Address - Fax:650-692-2655
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2024-04-05
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Provider Licenses
StateLicense IDTaxonomies
CAA644711223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Not Answered204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery