Provider Demographics
NPI:1740828292
Name:EMILY A. BOEHM DDS, LLC
Entity type:Organization
Organization Name:EMILY A. BOEHM DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOEHM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:513-821-0659
Mailing Address - Street 1:411 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:OH
Mailing Address - Zip Code:45215-4469
Mailing Address - Country:US
Mailing Address - Phone:513-821-0659
Mailing Address - Fax:513-821-0656
Practice Address - Street 1:411 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:OH
Practice Address - Zip Code:45215-4469
Practice Address - Country:US
Practice Address - Phone:513-821-0659
Practice Address - Fax:513-821-0656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty