MEDICARE: DR. DAVID G BOJRAB 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	126179	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6185590001	OTHER	IN	NGS DME MAC
2	6185590001	OTHER	IN	DME MAC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487664512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID G BOJRAB DDS

Provider Business Mailing Address
First Line	:	4606 D EAST STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-6963
Country	:	US
Telephone Number	:	260-423-2340
Fax Number	:	260-422-5342

Provider Business Practice Location Address
First Line	:	4606 D EAST STATE BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815
Country	:	US
Telephone Number	:	260-423-2340
Fax Number	:	260-422-5342

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

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	04/22/2009

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