Provider Demographics
NPI:1174741250
Name:BOEHNE, GARY W (DMD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:W
Last Name:BOEHNE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:GARY
Other - Middle Name:W
Other - Last Name:BOEHNE DMD PC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1320 CHEMEKETA ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4151
Mailing Address - Country:US
Mailing Address - Phone:503-363-9993
Mailing Address - Fax:503-399-7839
Practice Address - Street 1:1320 CHEMEKETA ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4151
Practice Address - Country:US
Practice Address - Phone:503-363-9993
Practice Address - Fax:503-399-7839
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD63181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice