Provider Demographics
NPI:1205941218
Name:BOEHME, GARY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:LYNN
Last Name:BOEHME
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 GARTH RD
Mailing Address - Street 2:#102
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3100
Mailing Address - Country:US
Mailing Address - Phone:281-422-4211
Mailing Address - Fax:281-420-2131
Practice Address - Street 1:4001 GARTH RD
Practice Address - Street 2:#102
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3100
Practice Address - Country:US
Practice Address - Phone:281-422-4211
Practice Address - Fax:281-420-2131
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10098122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist