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General NPI Number Information
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NPI Number | 1285041236
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Entity Type | Individual
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Provider Name | BOHDANNA CZERNIAK
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Gender | Female
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Dates
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Enumeration Date | 07/22/2014
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 8907 S HOWELL AVE
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City | OAK CREEK
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State | WI
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Zip | 53154-4460
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Country | US
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Telephone | 414-304-5425
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Fax |
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Provider Business Mailing Address
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Address Line | 1819 S MICHIGAN AVE UNIT 1008
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City | CHICAGO
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State | IL
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Zip | 60616-4646
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 1000966
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.030375
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License Number State | IL
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