Provider Demographics
NPI:1396071171
Name:BOHN, BRANDON RICHARD (DMD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:RICHARD
Last Name:BOHN
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 1:469 MEDICAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8922
Mailing Address - Country:US
Mailing Address - Phone:801-292-3012
Mailing Address - Fax:801-397-2058
Practice Address - Street 1:469 MEDICAL DR STE 200
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8922
Practice Address - Country:US
Practice Address - Phone:801-292-3012
Practice Address - Fax:801-397-2058
Is Sole Proprietor?:No
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7456327-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice