Provider Demographics
NPI:1033715081
Name:DONALD H. BOHNE, DDS, PA
Entity Type:Organization
Organization Name:DONALD H. BOHNE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:BOHNE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-939-6600
Mailing Address - Street 1:4958 LAVISTA RD
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4403
Mailing Address - Country:US
Mailing Address - Phone:770-939-6600
Mailing Address - Fax:770-939-1287
Practice Address - Street 1:4958 LAVISTA RD
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4403
Practice Address - Country:US
Practice Address - Phone:770-939-6600
Practice Address - Fax:770-939-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1629125869OtherNPPES