MEDICARE: DR. KELLEN MATTHEW BOHN D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DDS-09933	IA

General Provider Information

NPI Number	:	1316519838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLEN MATTHEW BOHN D.D.S

Provider Business Mailing Address
First Line	:	4551 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-2331
Country	:	US
Telephone Number	:	563-340-1527
Fax Number	:

Provider Business Practice Location Address
First Line	:	4551 FLEUR DR
Second Line	:
City	:	DES MOINES
State	:	IA
Zip	:	50321-2331
Country	:	US
Telephone Number	:	563-340-1527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	07/14/2021

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