Provider Demographics
NPI:1013011576
Name:BOBAK, WOJCIECH (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:WOJCIECH
Middle Name:
Last Name:BOBAK
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:VOYTEK
Other - Middle Name:
Other - Last Name:BOBAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1840 S. WADSWORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232
Mailing Address - Country:US
Mailing Address - Phone:303-988-0844
Mailing Address - Fax:303-988-7153
Practice Address - Street 1:1840 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-6831
Practice Address - Country:US
Practice Address - Phone:303-988-0844
Practice Address - Fax:303-988-7153
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO71901223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29651751Medicaid