Provider Demographics
NPI:1760653950
Name:BOHNENBERGER, ROBERT T (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:T
Last Name:BOHNENBERGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 W LINCOLN HWY
Mailing Address - Street 2:SUITE 50 WEST
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2521
Mailing Address - Country:US
Mailing Address - Phone:484-872-8032
Mailing Address - Fax:484-872-8034
Practice Address - Street 1:407 W LINCOLN HWY
Practice Address - Street 2:SUITE 50 WEST
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2521
Practice Address - Country:US
Practice Address - Phone:484-872-8032
Practice Address - Fax:484-872-8034
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-17
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030684L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice