Provider Demographics
NPI:1073304994
Name:BOEHM, RICHARD (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BOEHM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N LINDBERGH BLVD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7848
Mailing Address - Country:US
Mailing Address - Phone:314-427-2237
Mailing Address - Fax:
Practice Address - Street 1:211 N LINDBERGH BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7848
Practice Address - Country:US
Practice Address - Phone:314-427-2237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-13
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20240468871223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics