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General NPI Number Information
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NPI Number | 1013563303
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Entity Type | Individual
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Provider Name | KATHLEEN JO BOHR DDS
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Gender | Female
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Dates
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Enumeration Date | 08/13/2019
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 3308 KIMBALL AVE
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City | WATERLOO
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State | IA
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Zip | 50702-5758
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Country | US
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Telephone | 319-233-6177
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Fax |
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Provider Business Mailing Address
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Address Line | 319 SUNSET
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City | HUDSON
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State | IA
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Zip | 50643-2224
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Country | US
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Telephone | 563-203-0447
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DDS-09700
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License Number State | IA
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