Individual
DR. ANDREW WILLIAM BOHNSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
465 MEMORIAL DR, POCATELLO, ID 83201-4008
(208) 282-3289
Mailing address
921 S 8TH AVE STOP 8088, POCATELLO, ID 83209-8088
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D4367
ID
Other
Enumeration date
08/23/2011
Last updated
08/23/2011
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