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General NPI Number Information
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NPI Number | 1831309152
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Entity Type | Organization
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Legal Business Name | NEIL C BONSTROM DDS PA
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6550 YORK AVE S STE 302
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 952-920-0863
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Fax | 952-922-8314
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Provider Business Mailing Address
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Address Line | 6550 YORK AVE S STE 302
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City | EDINA
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State | MN
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Zip | 55435
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Country | US
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Telephone | 952-920-0863
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Fax | 952-922-8314
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. NEIL C BONSTROM
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Credential | DDS
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Telephone | 952-920-0863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D8226
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License Number State | MN
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