MEDICARE: DR. STANISLAV BOHONEK DDS

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	1223G0001X	General Practice Dentistry	30018485	OH

General Provider Information

NPI Number	:	1316152234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANISLAV BOHONEK DDS

Provider Business Mailing Address
First Line	:	30400 DETROIT RD
Second Line	:	SUITE 200
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1855
Country	:	US
Telephone Number	:	440-871-6610
Fax Number	:	440-871-5084

Provider Business Practice Location Address
First Line	:	30400 DETROIT RD
Second Line	:	SUITE 200
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1855
Country	:	US
Telephone Number	:	440-871-6610
Fax Number	:	440-871-5084

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

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	07/08/2007

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