Provider Demographics
NPI:1043308968
Name:BOJRAB, MATTHEW D (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:D
Last Name:BOJRAB
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10972 ALLISONVILLE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2637
Mailing Address - Country:US
Mailing Address - Phone:317-913-2363
Mailing Address - Fax:317-913-2370
Practice Address - Street 1:10972 ALLISONVILLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2637
Practice Address - Country:US
Practice Address - Phone:317-845-7878
Practice Address - Fax:317-570-7193
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120107744A1223S0112X
WI5633-0151223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200847900Medicaid
IN200847900Medicaid
IN268030PMedicare ID - Type Unspecified