| Organization Name: | BOHLE FAMILY DENTISTRY, PSC |
| NPI Number: | 1003135534 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHARLES J BOHLE (PRESIDENT) |
| Mailing Address: | 1836 Broadway St Paducah |
| State: | KY US |
| Postal Code: | 420012708 |
| Phone Number: | 2704420256 |
| Fax Number: | 2704428730 |
| NPI Enumeration Date: | 05/24/2010 |
| NPI Last Update Date: | 05/24/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |