Richard J Boehm, D.D.S.
Individual provider Active NPI Dentist · Wharton, TX
NPI 1780933754 · NPPES record last updated Sep 5, 2012
Key facts
- NPI
- 1780933754
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 15963 (TX)
- Practice address
- 808 N Fulton St
Wharton, TX 77488-3946 - Phone
- (979) 532-4400
- Fax
- (979) 532-1998
- NPI assigned
- Sep 5, 2012
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160720001220 | TX | Order and Referring Only - Dentist |
5597058149 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15963 | TX | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boehm Dental, PLLC | Dentist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 15963 | TX | Yes |
Addresses
Primary practice location
808 N Fulton St
Wharton, TX 77488-3946
Mailing address
808 N Fulton St
Wharton, TX 77488-3946
Phone (979) 532-4400
Other providers in Wharton, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.