MEDICARE: DR. WILLARD CHARLES BOEHM 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	1223G0001X	General Practice Dentistry	027999	NY

General Provider Information

NPI Number	:	1356346126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLARD CHARLES BOEHM D.D.S.

Provider Business Mailing Address
First Line	:	40 LANDSDOWNE LN
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14618-3848
Country	:	US
Telephone Number	:	585-586-3331
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 BROWNCROFT BLVD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-1410
Country	:	US
Telephone Number	:	585-381-1695
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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