Provider Demographics
NPI:1396081782
Name:BOHNSACK FAMILY DENTISTRY, PLLC
Entity type:Organization
Organization Name:BOHNSACK FAMILY DENTISTRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:BOHNSACK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:320-286-5333
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:100 3RD ST W
Mailing Address - City:COKATO
Mailing Address - State:MN
Mailing Address - Zip Code:55321-0669
Mailing Address - Country:US
Mailing Address - Phone:320-286-5333
Mailing Address - Fax:320-286-5631
Practice Address - Street 1:100 3RD ST SW
Practice Address - Street 2:
Practice Address - City:COKATO
Practice Address - State:MN
Practice Address - Zip Code:55321-4595
Practice Address - Country:US
Practice Address - Phone:320-286-5333
Practice Address - Fax:320-286-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN131571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty