Provider Demographics
NPI:1982774634
Name:BOOHER, ROBERT B (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:BOOHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10442 FOX TRACE
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077
Mailing Address - Country:US
Mailing Address - Phone:317-873-5529
Mailing Address - Fax:317-272-2785
Practice Address - Street 1:7800 EAST US 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7156
Practice Address - Country:US
Practice Address - Phone:317-272-2700
Practice Address - Fax:317-272-2785
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007216A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice