=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508925769
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEATHER FERAY BOHAN DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 LAWRENCE ST SUITE 200
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-357-5002
-----------------------------------------------------
Fax | 281-255-3016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 720 LAWRENCE ST SUITE 200
-----------------------------------------------------
City | TOMBALL
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77375
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-357-5002
-----------------------------------------------------
Fax | 281-255-3016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER GENERAL DENTIST
-----------------------------------------------------
Name | HEATHER DANIELLE FERAY BOHAN
-----------------------------------------------------
Credential | DDS PA
-----------------------------------------------------
Telephone | 281-357-5002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 20540
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 101201
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 126800000X
-----------------------------------------------------
Taxonomy Name | Dental Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------