Healthcare Provider Details

I. General information

NPI: 1912990243
Provider Name (Legal Business Name): DAVID IRWIN BOEHR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19352 SW BOONES FERRY RD
TUALATIN OR
97062-9084
US

IV. Provider business mailing address

19352 SW BOONES FERRY RD
TUALATIN OR
97062-9084
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-3060
  • Fax:
Mailing address:
  • Phone: 503-692-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5414
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: