Provider Demographics
NPI:1255442752
Name:BOEHM, LINDA MICHELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:MICHELLE
Last Name:BOEHM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 N LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-1125
Mailing Address - Country:US
Mailing Address - Phone:315-363-5081
Mailing Address - Fax:315-366-3694
Practice Address - Street 1:415 N LAKE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-1125
Practice Address - Country:US
Practice Address - Phone:315-363-5081
Practice Address - Fax:315-366-3694
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist