Provider Demographics
NPI:1871626028
Name:BOHNE, CARROLL DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:CARROLL
Middle Name:DOUGLAS
Last Name:BOHNE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DOUGLAS
Other - Middle Name:
Other - Last Name:BOHNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:26032 MARGUERITE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5281
Mailing Address - Country:US
Mailing Address - Phone:949-348-0880
Mailing Address - Fax:949-348-1627
Practice Address - Street 1:26032 MARGUERITE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5281
Practice Address - Country:US
Practice Address - Phone:949-348-0880
Practice Address - Fax:949-348-1627
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist