Provider Demographics
NPI:1063611721
Name:BOHNING, BRYAN PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:PAUL
Last Name:BOHNING
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 1:4051 VETERANS BLVD
Mailing Address - Street 2:STE 312
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-888-4034
Mailing Address - Fax:504-888-4036
Practice Address - Street 1:4051 VETERANS BLVD
Practice Address - Street 2:STE 312
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-888-4034
Practice Address - Fax:504-888-4036
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics