MEDICARE: JOHN BOZIC D.D.S.

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	1223P0221X	Pediatric Dentistry	7580	IN

General Provider Information

NPI Number	:	1841381928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BOZIC D.D.S.

Provider Business Mailing Address
First Line	:	8930 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2132
Country	:	US
Telephone Number	:	317-271-6060
Fax Number	:	317-271-6065

Provider Business Practice Location Address
First Line	:	8930 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2132
Country	:	US
Telephone Number	:	317-271-6060
Fax Number	:	317-271-6065

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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Directions to “ JOHN BOZIC D.D.S.” Practice Location

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