Provider Demographics
NPI:1497134597
Name:JAMES BOHN III DMD PLLC
Entity Type:Organization
Organization Name:JAMES BOHN III DMD PLLC
Other - Org Name:WAKE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOHN
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:919-363-3133
Mailing Address - Street 1:3100 NC 55 HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8427
Mailing Address - Country:US
Mailing Address - Phone:919-363-3133
Mailing Address - Fax:919-363-3134
Practice Address - Street 1:3100 NC 55 HWY STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8427
Practice Address - Country:US
Practice Address - Phone:919-363-3133
Practice Address - Fax:919-363-3134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8872122300000X
NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8872OtherLICENSE