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General NPI Number Information
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NPI Number | 1174642581
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Entity Type | Organization
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Legal Business Name | PAUL H. BOEHME, D.D.S., P.C.
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5430 LEMAY FERRY RD SUITE 3
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City | SAINT LOUIS
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State | MO
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Zip | 63129-2378
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Country | US
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Telephone | 314-892-8853
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Fax | 314-892-9726
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Provider Business Mailing Address
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Address Line | 5430 LEMAY FERRY RD SUITE 3
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City | SAINT LOUIS
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State | MO
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Zip | 63129-2378
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Country | US
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Telephone | 314-892-8853
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Fax | 314-892-9726
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL HERBERT BOEHME
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Credential | DDS
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Telephone | 314-892-8853
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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 | 014743
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License Number State | MO
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