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General NPI Number Information
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NPI Number | 1174417935
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Entity Type | Organization
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Legal Business Name | BOEHM DENTAL SPECIALISTS PC
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 06/05/2025
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Provider Practice Location Address
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Address Line | 16465 SIERRA LAKES PKWY STE 230
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City | FONTANA
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State | CA
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Zip | 92336-1242
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Country | US
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Telephone | 909-775-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 16465 SIERRA LAKES PKWY STE 230
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City | FONTANA
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State | CA
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Zip | 92336-1242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. TOBIAS K BOEHM
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Credential | DDS
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Telephone | 909-740-4476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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