MEDICARE: DR. GARY A LOZENICH DDS

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	122300000X	Dentist	015660	MI

General Provider Information

NPI Number	:	1265651129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY A LOZENICH DDS

Provider Business Mailing Address
First Line	:	4045 W 13 MILE RD STE B5
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6640
Country	:	US
Telephone Number	:	248-280-4500
Fax Number	:	248-280-4502

Provider Business Practice Location Address
First Line	:	4045 W 13 MILE RD STE B5
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48073-6640
Country	:	US
Telephone Number	:	248-280-4500
Fax Number	:	248-280-4502

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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