Provider Demographics
NPI:1669575189
Name:BOEHMKE, KATHLEEN D (DDS)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:D
Last Name:BOEHMKE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:D
Other - Last Name:JANACEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1309
Mailing Address - Street 2:MAIL CODE 21113A
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-1309
Mailing Address - Country:US
Mailing Address - Phone:952-883-5151
Mailing Address - Fax:952-883-5160
Practice Address - Street 1:8325 SEASONS PARKWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125
Practice Address - Country:US
Practice Address - Phone:651-702-5845
Practice Address - Fax:651-702-5870
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN83861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice