Timothy John Boehm, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D5027 Issued in OR

Practice address

3000 Market St NE
Salem, OR 97301-1882

Phone

(503) 585-5205

NPI assigned

Jun 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335398400000",
    "number": "1508809104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1488 BOULDER CREEK ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973016958",
            "telephone_number": "503-999-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 MARKET ST NE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973011882",
            "telephone_number": "503-585-5205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOEHM",
        "first_name": "TIMOTHY",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2012-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D5027",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "027914",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Dale Bodin, QMHA, C.A.D.C. I
• Trevor Bodine, PTA
• Peter Bodmer
• Ekaterina Bodunov
• Victoria Boechler, PT, DPT
• Gary W Boehne, DMD
• Brogan Boen
• Gavin Boen
• Bruce William Boer, DDS
• Chris Daniel Boga, LMT

• General Practice Dentistry in Salem, OR
• Providers in Salem, OR by specialty
• General Practice Dentistry in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.