Active NPI
Gen Bohm Paek, D.D.S.
- Prosthodontics
- Fort Cavazos, TX
National Provider Identifier
1013964154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Prosthodontics
- License
- 26577
- Practice address
- 36014 Wratten Dr
Ft Cavazos, TX 76544 - Phone
- (254) 289-1005
- NPI assigned
- May 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Prosthodontics | 1223P0700X | 26577 | TX | Primary |
Addresses
Primary practice location
36014 Wratten Dr
Ft Cavazos, TX 76544
Mailing address
36014 Wratten Dr
Ft Cavazos, TX 76544
Phone (254) 289-7531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 26577 | TX | MD | Prosthodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148688000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701907200000",
"number": "1013964154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36014 WRATTEN DR",
"city": "FT CAVAZOS",
"state": "TX",
"postal_code": "76544",
"telephone_number": "254-289-7531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36014 WRATTEN DR",
"city": "FT CAVAZOS",
"state": "TX",
"postal_code": "76544",
"telephone_number": "254-289-1005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PAEK",
"first_name": "GEN",
"middle_name": "BOHM",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-27",
"last_updated": "2023-12-07",
"certification_date": "2023-12-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0700X",
"taxonomy_group": "",
"desc": "Dentist, Prosthodontics",
"state": "TX",
"license": "26577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Cavazos, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.