Provider Demographics
NPI:1629125869
Name:BOHNE, DONALD HOYT (DDS)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:HOYT
Last Name:BOHNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4958 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA74031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice