MEDICARE: DR. BOGDAN MIHAI TARAN 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	122300000X	Dentist	019027941	IL

General Provider Information

NPI Number	:	1477789352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOGDAN MIHAI TARAN DDS

Provider Business Mailing Address
First Line	:	529 TENNEY ST
Second Line	:
City	:	KEWANEE
State	:	IL
Zip	:	61443-3746
Country	:	US
Telephone Number	:	309-853-3684
Fax Number	:	309-852-0140

Provider Business Practice Location Address
First Line	:	529 TENNEY ST
Second Line	:
City	:	KEWANEE
State	:	IL
Zip	:	61443-3746
Country	:	US
Telephone Number	:	309-853-3684
Fax Number	:	309-852-0140

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

Provider Enumeration Date	:	06/04/2009
Last Update Date	:	06/04/2009

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