Provider Demographics
NPI:1881790715
Name:BOADI, ABRAHAM HUMPHREY (DMD)
Entity type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:HUMPHREY
Last Name:BOADI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 S BYRNE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-6211
Mailing Address - Country:US
Mailing Address - Phone:419-534-2479
Mailing Address - Fax:419-534-3260
Practice Address - Street 1:36 S BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-6211
Practice Address - Country:US
Practice Address - Phone:419-534-2479
Practice Address - Fax:419-534-3260
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0188421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH01541OtherPARAMOUNT HELTHCARE
OH432095956OtherTAX IDENTIFICATION
OH0719486Medicaid