Healthcare Provider Details

I. General information

NPI: 1790803583
Provider Name (Legal Business Name): NEAL BOZENTKA D.M. D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 S CHESTER RD
SWARTHMORE PA
19081-2224
US

IV. Provider business mailing address

700 SOUTH CHESTER ROAD
SWARTHMORE PA
19081
US

V. Phone/Fax

Practice location:
  • Phone: 610-328-0773
  • Fax: 610-328-6859
Mailing address:
  • Phone: 610-328-0773
  • Fax: 610-328-6859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDS027359L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. MARIANN SMITH
Title or Position: OFFICE MANAGER
Credential:
Phone: 610-328-0773