Provider Demographics
NPI:1437240736
Name:SWENBY, BONNIE WACHTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:WACHTER
Last Name:SWENBY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 98TH ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-4713
Mailing Address - Country:US
Mailing Address - Phone:952-881-2243
Mailing Address - Fax:952-888-6988
Practice Address - Street 1:525 W 98TH ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-4713
Practice Address - Country:US
Practice Address - Phone:952-881-2243
Practice Address - Fax:952-888-6988
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN105401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice