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General NPI Number Information
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NPI Number | 1861674699
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Entity Type | Organization
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Legal Business Name | BLAINE TRAVIS BOHRER, DDS
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 1577 GENERAL BOOTH BLVD #107
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5105
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Country | US
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Telephone | 757-428-8282
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Fax | 757-437-0415
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Provider Business Mailing Address
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Address Line | 1577 GENERAL BOOTH BLVD #107
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-5105
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Country | US
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Telephone | 757-428-8282
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Fax | 757-437-0415
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Authorized Official
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Title or Position | DENTIST
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Name | DR. BLAINE TRAVIS BOHRER
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Credential | DDS
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Telephone | 757-428-8282
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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 | 0401410722
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License Number State | VA
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