Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | DDS43902 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | S2-156C | NV |
NPI | 1336271170 |
---|---|
Provider Name | Dr. Paul Gunnar Bohman |
First Address | Ventura, CA 93003-6555 |
Second Address | Ventura, CA 93003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/03/2007 |
Last Update Date | 23/08/2018 |