MEDICARE: DR. RICHARD JOHN BOBULSKY DDS, MSD

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	1223P0300X	Periodontics	17306	OH

General Provider Information

NPI Number	:	1285689570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD JOHN BOBULSKY DDS, MSD

Provider Business Mailing Address
First Line	:	7057 W 130TH ST
Second Line	:	SUITE 203
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-7841
Country	:	US
Telephone Number	:	440-885-4200
Fax Number	:	440-885-0082

Provider Business Practice Location Address
First Line	:	7057 W 130TH ST
Second Line	:	SUITE 203
City	:	PARMA HEIGHTS
State	:	OH
Zip	:	44130-7841
Country	:	US
Telephone Number	:	440-885-4200
Fax Number	:	440-885-0082

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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