MEDICARE: DR. GLORIA MICHELLE BOZA D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN14262	FL

General Provider Information

NPI Number	:	1255462768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLORIA MICHELLE BOZA D.M.D.

Provider Business Mailing Address
First Line	:	2602 W SLIGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-4342
Country	:	US
Telephone Number	:	813-930-5604
Fax Number	:	813-930-6038

Provider Business Practice Location Address
First Line	:	2602 W SLIGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-4342
Country	:	US
Telephone Number	:	813-930-5604
Fax Number	:	813-930-6038

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/09/2007

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