Provider Demographics
NPI:1265644306
Name:BOZICH, JOHN G (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:G
Last Name:BOZICH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:700 NE MULTNOMAH ST
Mailing Address - Street 2:SUITE 840
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2131
Mailing Address - Country:US
Mailing Address - Phone:503-232-4488
Mailing Address - Fax:503-239-4075
Practice Address - Street 1:700 NE MULTNOMAH ST
Practice Address - Street 2:SUITE 840
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2131
Practice Address - Country:US
Practice Address - Phone:503-232-4488
Practice Address - Fax:503-239-4075
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD66111223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORD6611OtherSTATE OF OREGON DENTAL
OR159012Medicaid
OR159012Medicaid
ORU59844Medicare UPIN
OR159012Medicaid