MEDICARE: BOZIC PEDIATRIC DENTISTRY, P.C.

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	1223P0221X	Pediatric Dentistry	7580	IN

General Provider Information

NPI Number	:	1447616545
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOZIC PEDIATRIC DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	8930 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2132
Country	:	US
Telephone Number	:	317-271-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	8930 W 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2132
Country	:	US
Telephone Number	:	317-271-6060
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	JAMIE HOLLAND
Credential	:
Telephone Number	:	317-271-6060

Provider Enumeration Date	:	01/06/2016
Last Update Date	:	01/06/2016

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