Healthcare Provider Details

I. General information

NPI: 1518078310
Provider Name (Legal Business Name): DR DONALD F BOZIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 MEDICAL DR SUITE C
CARMEL IN
46032
US

IV. Provider business mailing address

370 MEDICAL DR SUITE C
CARMEL IN
46032
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-6261
  • Fax: 317-844-4207
Mailing address:
  • Phone: 317-844-6261
  • Fax: 317-844-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number6377
License Number StateIN

VIII. Authorized Official

Name: DR. DONALD F BOZIC
Title or Position: PRESIDENT
Credential: DDS
Phone: 317-844-6261