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NPI Code Detail

MEDICARE: DR. GREGORY PAUL BOBAK DDS

MEDICARE: DR. GREGORY PAUL BOBAK DDS
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
11223G0001XGeneral Practice Dentistry019028992IL

General Provider Information

NPI Number : 1699037424
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY PAUL BOBAK DDS
Provider Business Mailing Address
First Line : 230 E 8TH ST
Second Line : SUITE C
City : LOCKPORT
State : IL
Zip : 60441-3081
Country : US
Telephone Number : 815-838-6102
Fax Number :
Provider Business Practice Location Address
First Line : 230 E 8TH ST
Second Line : SUITE C
City : LOCKPORT
State : IL
Zip : 60441-3081
Country : US
Telephone Number : 815-838-6102
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2012
Last Update Date : 06/07/2012

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