Healthcare Provider Details

I. General information

NPI: 1982901674
Provider Name (Legal Business Name): WOJCIECH K DOBRACKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2011
Last Update Date: 10/09/2021
Certification Date: 10/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 W STADIUM BLVD
ANN ARBOR MI
48103-6963
US

IV. Provider business mailing address

606 W STADIUM BLVD
ANN ARBOR MI
48103-6963
US

V. Phone/Fax

Practice location:
  • Phone: 734-747-6400
  • Fax:
Mailing address:
  • Phone: 734-747-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6647-15
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901020594
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: