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NPI Code Detail

MEDICARE: CODIE BONTZ DDS, MS

MEDICARE:   CODIE  BONTZ  DDS, MS
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry37977TX

General Provider Information

NPI Number : 1164186805
Entity Type Code : Individual
Provider Name (Legal Business Name) : CODIE BONTZ DDS, MS
Provider Business Mailing Address
First Line : 5848 ABRAMS RD
Second Line :
City : DALLAS
State : TX
Zip : 75214-1603
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5848 ABRAMS RD
Second Line :
City : DALLAS
State : TX
Zip : 75214-1603
Country : US
Telephone Number : 214-545-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2021
Last Update Date : 02/05/2022

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Directions to “ CODIE BONTZ DDS, MS” Practice Location

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