Individual
DR. TIMOTHY JOHN BOEHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3000 MARKET ST NE, SALEM, OR 97301-1882
(503) 585-5205
Mailing address
1488 BOULDER CREEK ST SE, SALEM, OR 97301-6958
(503) 999-6115
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D5027
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
027914
—
OR
Enumeration date
06/13/2006
Last updated
04/26/2012
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