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General NPI Number Information
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NPI Number | 1366742819
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Entity Type | Organization
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Legal Business Name | ALBERT BOHOLST, DMD, PA
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Dates
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Enumeration Date | 11/01/2010
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 2623 N FOREST RIDGE BLVD
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City | HERNANDO
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State | FL
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Zip | 34442-5123
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Country | US
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Telephone | 813-746-4684
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Fax |
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Provider Business Mailing Address
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Address Line | 27510 CASHFORD CIR
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-6910
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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 | DENTIST
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Name | ALBERT BOHOLST
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Credential |
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Telephone | 813-973-8555
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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