Provider Demographics
NPI:1285704791
Name:BOEHLY, KATHRYN E (DMD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:E
Last Name:BOEHLY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ELAINE
Other - Last Name:BOEHLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6290 LINTON BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484
Mailing Address - Country:US
Mailing Address - Phone:561-381-4744
Mailing Address - Fax:561-384-4743
Practice Address - Street 1:6290 LINTON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484
Practice Address - Country:US
Practice Address - Phone:561-381-4744
Practice Address - Fax:561-384-4743
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 130551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice