Provider Demographics
NPI:1356369516
Name:RHEA-BOHNENKAMP, TAMMY SUE (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:SUE
Last Name:RHEA-BOHNENKAMP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:RHEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2730 PIERCE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-3764
Mailing Address - Country:US
Mailing Address - Phone:712-899-9704
Mailing Address - Fax:833-463-2318
Practice Address - Street 1:2730 PIERCE ST STE 202
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-3764
Practice Address - Country:US
Practice Address - Phone:127-899-9704
Practice Address - Fax:833-463-2318
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA074331223X2210X, 1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X2210XDental ProvidersDentistOrofacial PainGroup - Multi-Specialty