Provider Demographics
NPI:1124646120
Name:BOHRER, BRANDON J (DMD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:J
Last Name:BOHRER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-5224
Mailing Address - Country:US
Mailing Address - Phone:585-507-2684
Mailing Address - Fax:
Practice Address - Street 1:1745 S HIGHLAND AVE STE 6W
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-1852
Practice Address - Country:US
Practice Address - Phone:727-586-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25137122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist