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NPI Code Detail

MEDICARE: PAUL WADE BOZZO D.D.S.

MEDICARE: PAUL WADE BOZZO D.D.S.
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
11223G0001XGeneral Practice Dentistry14465TX

General Provider Information

NPI Number : 1447260625
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAUL WADE BOZZO D.D.S.
Provider Business Mailing Address
First Line : 1 N MAIN ST
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3710
Country : US
Telephone Number : 281-359-8302
Fax Number : 281-360-7708
Provider Business Practice Location Address
First Line : 1 N MAIN ST
Second Line :
City : KINGWOOD
State : TX
Zip : 77339-3710
Country : US
Telephone Number : 281-359-8302
Fax Number : 281-360-7708
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2006
Last Update Date : 07/08/2007

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