Provider Demographics
NPI:1275297673
Name:OWOSSO ORTHODONTICS
Entity Type:Organization
Organization Name:OWOSSO ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZANG-BODIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-725-5373
Mailing Address - Street 1:323 N BALL ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2824
Mailing Address - Country:US
Mailing Address - Phone:989-725-5373
Mailing Address - Fax:989-729-1329
Practice Address - Street 1:323 N BALL ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2824
Practice Address - Country:US
Practice Address - Phone:989-725-5373
Practice Address - Fax:989-729-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty