Provider Demographics
NPI:1477789352
Name:TARAN, BOGDAN MIHAI (DDS)
Entity Type:Individual
Prefix:DR
First Name:BOGDAN
Middle Name:MIHAI
Last Name:TARAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 TENNEY ST
Mailing Address - Street 2:
Mailing Address - City:KEWANEE
Mailing Address - State:IL
Mailing Address - Zip Code:61443-3746
Mailing Address - Country:US
Mailing Address - Phone:309-853-3684
Mailing Address - Fax:309-852-0140
Practice Address - Street 1:529 TENNEY ST
Practice Address - Street 2:
Practice Address - City:KEWANEE
Practice Address - State:IL
Practice Address - Zip Code:61443-3746
Practice Address - Country:US
Practice Address - Phone:309-853-3684
Practice Address - Fax:309-852-0140
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027941122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist