Provider Demographics
NPI:1912017237
Name:BOHNSACK, BRUCE A (DDS)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:A
Last Name:BOHNSACK
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:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:COKATA
Mailing Address - State:MN
Mailing Address - Zip Code:55321
Mailing Address - Country:US
Mailing Address - Phone:320-286-5333
Mailing Address - Fax:320-286-5631
Practice Address - Street 1:100 W 3RD ST
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321
Practice Address - Country:US
Practice Address - Phone:320-286-5333
Practice Address - Fax:320-286-5631
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8315122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist