Healthcare Provider Details

I. General information

NPI: 1366742819
Provider Name (Legal Business Name): ALBERT BOHOLST, DMD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2623 N FOREST RIDGE BLVD
HERNANDO FL
34442-5123
US

IV. Provider business mailing address

27510 CASHFORD CIR
WESLEY CHAPEL FL
33544-6910
US

V. Phone/Fax

Practice location:
  • Phone: 813-746-4684
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: ALBERT BOHOLST
Title or Position: DENTIST
Credential:
Phone: 813-973-8555