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General NPI Number Information
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NPI Number | 1669533832
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Entity Type | Organization
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Legal Business Name | WILLIAM B. BOHANNAN DDS, MD, PC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1750 EL CAMINO REAL SUITE 403
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City | BURLINGAME
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State | CA
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Zip | 94010-3228
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Country | US
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Telephone | 650-692-1530
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Fax | 650-692-2655
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Provider Business Mailing Address
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Address Line | 1750 EL CAMINO REAL SUITE 403
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City | BURLINGAME
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State | CA
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Zip | 94010-3228
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Country | US
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Telephone | 650-692-1530
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Fax | 650-692-2655
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. WILLIAM B BOHANNAN
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Credential | D.D.S., M.D.
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Telephone | 650-692-1530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | A64471
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License Number State | CA
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