Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 7190 | CO |
NPI | 1013011576 |
---|---|
Provider Name | Dr. Wojciech Bobak |
First Address | Lakewood, CO 80232 |
Second Address | Lakewood, CO 80232-6831 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2006 |
Last Update Date | 13/10/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29651751 | (05) | CO |