Provider Demographics
NPI:1568521995
Name:BAHNEMANN, CAROL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:BAHNEMANN
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 1:4941 BRYANT AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5360
Mailing Address - Country:US
Mailing Address - Phone:612-823-0583
Mailing Address - Fax:
Practice Address - Street 1:11269 JEFFERSON HWY N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3123
Practice Address - Country:US
Practice Address - Phone:763-421-5206
Practice Address - Fax:763-421-8320
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND104921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice