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NPI Code Detail

MEDICARE: DR. GAIL E BODZIOCH DMD

MEDICARE: DR. GAIL E BODZIOCH DMD
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
1122300000XDentist006854CT

General Provider Information

NPI Number : 1891911525
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GAIL E BODZIOCH DMD
Provider Business Mailing Address
First Line : PO BOX 711
Second Line :
City : ROCKY HILL
State : CT
Zip : 06067-0711
Country : US
Telephone Number : 860-563-1295
Fax Number : 860-563-9399
Provider Business Practice Location Address
First Line : 412 CROMWELL AVE
Second Line :
City : ROCKY HILL
State : CT
Zip : 06067-1834
Country : US
Telephone Number : 860-563-1294
Fax Number : 860-563-1294
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2007
Last Update Date : 07/08/2007

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