Provider Demographics
NPI:1972724904
Name:JANEK, BRUCE STANLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:STANLEY
Last Name:JANEK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13902 MOSS CREEK PLACE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112
Mailing Address - Country:US
Mailing Address - Phone:804-639-7727
Mailing Address - Fax:
Practice Address - Street 1:3600 WOODS WAY
Practice Address - Street 2:
Practice Address - City:STATE FARM
Practice Address - State:VA
Practice Address - Zip Code:23160
Practice Address - Country:US
Practice Address - Phone:804-598-4251
Practice Address - Fax:804-403-3495
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist