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General NPI Number Information
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NPI Number | 1972736346
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Entity Type | Individual
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Provider Name | JAN M. BOHONEK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2009
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Last Update Date | 09/01/2009
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Provider Practice Location Address
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Address Line | 11351 PEARL RD SUITE 302
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City | STRONGSVILLE
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State | OH
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Zip | 44136-3331
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Country | US
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Telephone | 440-846-8833
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Fax | 440-846-8920
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Provider Business Mailing Address
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Address Line | 11351 PEARL RD SUITE 302
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City | STRONGSVILLE
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State | OH
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Zip | 44136-3331
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Country | US
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Telephone | 440-846-8833
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Fax | 440-846-8920
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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 | 30.018311
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License Number State | OH
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