MEDICARE: LUBOMIR BOJIDAROV SERAFIMOV 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	122300000X	Dentist	D11864	MN

General Provider Information

NPI Number	:	1871693580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUBOMIR BOJIDAROV SERAFIMOV D.D.S.

Provider Business Mailing Address
First Line	:	250 WENTWORTH AVE E
Second Line	:
City	:	WEST SAINT PAUL
State	:	MN
Zip	:	55118-3507
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 WENTWORTH AVE E
Second Line	:
City	:	WEST SAINT PAUL
State	:	MN
Zip	:	55118-3507
Country	:	US
Telephone Number	:	651-455-1601
Fax Number	:	651-455-1820

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

Provider Enumeration Date	:	09/23/2006
Last Update Date	:	07/08/2007

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