Individual
DR. EDWARD W. BOEHM JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
112 LEXINGTON AVE, PASSAIC, NJ 07055-5244
(973) 777-6688
Mailing address
112 LEXINGTON AVE, PASSAIC, NJ 07055-5244
(973) 777-6688
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
13587
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10515
DORAL DENTAL IDENTIFIER
NJ
05
—
1616609
—
NJ
Enumeration date
01/23/2007
Last updated
07/08/2007
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