Provider Demographics
NPI:1336271170
Name:BOHMAN, PAUL GUNNAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:GUNNAR
Last Name:BOHMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1280 S VICTORIA AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6555
Mailing Address - Country:US
Mailing Address - Phone:805-642-8672
Mailing Address - Fax:805-642-8686
Practice Address - Street 1:1280 S VICTORIA AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-642-8672
Practice Address - Fax:805-642-8686
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CADDS439021223P0106X
NVS2-156C1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology