Provider Demographics
NPI:1063539849
Name:BOECLER, PAUL RICHARD (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:RICHARD
Last Name:BOECLER
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Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:958 JOE FRANK HARRIS PKWY SE BLDG A
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-2151
Mailing Address - Country:US
Mailing Address - Phone:770-386-2442
Mailing Address - Fax:770-386-2442
Practice Address - Street 1:958 JOE FRANK HARRIS PKWY SE BLDG A
Practice Address - Street 2:SUITE 104
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-2151
Practice Address - Country:US
Practice Address - Phone:770-386-2442
Practice Address - Fax:770-386-2442
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0097921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics