Provider Demographics
NPI:1639516065
Name:BOJRAB, NATHAN J (DDS)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:BOJRAB
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 1:2801 MAPLECREST RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-7015
Mailing Address - Country:US
Mailing Address - Phone:260-486-4444
Mailing Address - Fax:260-486-4596
Practice Address - Street 1:2801 MAPLECREST RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-7015
Practice Address - Country:US
Practice Address - Phone:260-486-4444
Practice Address - Fax:260-486-4596
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011957A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice