Provider Demographics
NPI:1831812148
Name:BOHNSTEDT, RYAN WALTER (DMD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WALTER
Last Name:BOHNSTEDT
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 1:300 SE 120TH AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-4020
Mailing Address - Country:US
Mailing Address - Phone:360-256-3570
Mailing Address - Fax:
Practice Address - Street 1:300 SE 120TH AVE STE 400
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-4020
Practice Address - Country:US
Practice Address - Phone:360-256-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE613569781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice