MEDICARE: DR. GEN BOHM PAEK D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	26577	TX

General Provider Information

NPI Number	:	1013964154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEN BOHM PAEK D.D.S.

Provider Business Mailing Address
First Line	:	36014 WRATTEN DR
Second Line	:
City	:	FT CAVAZOS
State	:	TX
Zip	:	76544
Country	:	US
Telephone Number	:	254-289-7531
Fax Number	:

Provider Business Practice Location Address
First Line	:	36014 WRATTEN DR
Second Line	:
City	:	FT CAVAZOS
State	:	TX
Zip	:	76544
Country	:	US
Telephone Number	:	254-289-1005
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	12/07/2023

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