Provider Demographics
NPI:1285689570
Name:BOBULSKY, RICHARD JOHN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JOHN
Last Name:BOBULSKY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7057 W 130TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-7841
Mailing Address - Country:US
Mailing Address - Phone:440-885-4200
Mailing Address - Fax:440-885-0082
Practice Address - Street 1:7057 W 130TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-7841
Practice Address - Country:US
Practice Address - Phone:440-885-4200
Practice Address - Fax:440-885-0082
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH173061223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics