Provider Demographics
NPI:1417923681
Name:BOUZIS, JOHN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LEE
Last Name:BOUZIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 N ASH ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-1821
Mailing Address - Country:US
Mailing Address - Phone:307-265-3595
Mailing Address - Fax:307-265-0778
Practice Address - Street 1:130 N ASH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-1821
Practice Address - Country:US
Practice Address - Phone:307-265-3595
Practice Address - Fax:307-265-0778
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY6411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice