Healthcare Provider Details

I. General information

NPI: 1275297673
Provider Name (Legal Business Name): OWOSSO ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2021
Last Update Date: 10/22/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N BALL ST
OWOSSO MI
48867-2824
US

IV. Provider business mailing address

323 N BALL ST
OWOSSO MI
48867-2824
US

V. Phone/Fax

Practice location:
  • Phone: 989-725-5373
  • Fax: 989-729-1329
Mailing address:
  • Phone: 989-725-5373
  • Fax: 989-729-1329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN ZANG-BODIS
Title or Position: DDS
Credential:
Phone: 989-725-5373