Healthcare Provider Details

I. General information

NPI: 1811439912
Provider Name (Legal Business Name): WOJCIECH BOBAK DMD MS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 S WADSWORTH BLVD
LAKEWOOD CO
80232-6831
US

IV. Provider business mailing address

1840 S WADSWORTH BLVD
LAKEWOOD CO
80232-6831
US

V. Phone/Fax

Practice location:
  • Phone: 303-988-0844
  • Fax:
Mailing address:
  • Phone: 303-988-0844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7190
License Number StateCO

VIII. Authorized Official

Name: DR. WOJCIECH BOBAK
Title or Position: OWNER
Credential: DMD MS
Phone: 303-988-0844