Bruce Stanley Janek, D.M.D.
Individual provider Active NPI Dentist · State Farm, VA
NPI 1972724904 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1972724904
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 0401008702 (VA)
- Practice address
- 3600 Woods Way
State Farm, VA 23160 - Phone
- (804) 598-4251
- Fax
- (804) 403-3495
- NPI assigned
- May 1, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401008702 | VA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 0401008702 | VA | Yes |
Addresses
Primary practice location
3600 Woods Way
State Farm, VA 23160
Mailing address
13902 Moss Creek Place
Midlothian, VA 23112
Phone (804) 639-7727
Other providers in State Farm, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 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.