Bruce John Bobofchak, DDS,MS
Individual provider Active NPI Oral and Maxillofacial Surgery (Dentist) · Galesburg, IL
NPI 1700865284 · NPPES record last updated Aug 2, 2007
Key facts
- NPI
- 1700865284
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Oral and Maxillofacial Surgery (Dentist) 1223S0112X
- Practice address
- 929 W Carl Sandburg Dr
Galesburg, IL 61401-1342 - Phone
- (309) 344-3311
- Fax
- (309) 344-1052
- NPI assigned
- Jan 12, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019014728 | IL | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Western Illinois Oral & Maxillofacial Surgery, LTD. | Oral and Maxillofacial Surgery | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | IL | Yes |
Addresses
Primary practice location
929 W Carl Sandburg Dr
Galesburg, IL 61401-1342
Mailing address
929 W Carl Sandburg Dr
Galesburg, IL 61401-1342
Phone (309) 344-3311
Other providers in Galesburg, IL
- James Allan Berg Jr.
- Bess-Tabb & Associates, LLC
- Tania Cynara de Sousa Bezerra
- John Robert Bicego Jr.
- Angela M Bickett
- Ashlyn Boggs
- William Todd Bollaert
- Veerasikku Bommiasamy
- Ryan James Bonham
- Sara Kimberly Bosworth
All providers in Galesburg, IL · Oral and Maxillofacial Surgery (Dentist) in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 2, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.