Provider Demographics
NPI:1972240224
Name:BOHN DENTAL
Entity Type:Organization
Organization Name:BOHN DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST, SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:KEEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOHN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-425-8892
Mailing Address - Street 1:3686 32ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HUDSONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49426-8546
Mailing Address - Country:US
Mailing Address - Phone:616-425-8892
Mailing Address - Fax:616-216-6943
Practice Address - Street 1:3686 32ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:HUDSONVILLE
Practice Address - State:MI
Practice Address - Zip Code:49426-8546
Practice Address - Country:US
Practice Address - Phone:616-425-8892
Practice Address - Fax:616-216-6943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental