Provider Demographics
NPI:1972736346
Name:BOHONEK, JAN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:M
Last Name:BOHONEK
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 1:11351 PEARL RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44136-3331
Mailing Address - Country:US
Mailing Address - Phone:440-846-8833
Mailing Address - Fax:440-846-8920
Practice Address - Street 1:11351 PEARL RD
Practice Address - Street 2:SUITE 302
Practice Address - City:STRONGSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44136-3331
Practice Address - Country:US
Practice Address - Phone:440-846-8833
Practice Address - Fax:440-846-8920
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0183111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOHIO 18311OtherOHIO (SHORT VERSION OF OHIO DENTAL LICENSE NUMBER)