Provider Demographics
NPI:1417385907
Name:BODNAR & WYATT, PLLC
Entity Type:Organization
Organization Name:BODNAR & WYATT, PLLC
Other - Org Name:CATALOOCHEE DENTAL ASHEVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENGE
Authorized Official - Suffix:
Authorized Official - Credentials:CDPMA
Authorized Official - Phone:828-627-1050
Mailing Address - Street 1:900 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1734
Mailing Address - Country:US
Mailing Address - Phone:828-277-6800
Mailing Address - Fax:828-277-6820
Practice Address - Street 1:900 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1734
Practice Address - Country:US
Practice Address - Phone:828-277-6800
Practice Address - Fax:828-277-6820
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BODNAR & WYATT, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-22
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty