Provider Demographics
NPI:1619098670
Name:H P BOZARD DDS PA
Entity Type:Organization
Organization Name:H P BOZARD DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOZARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-433-8090
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102
Mailing Address - Country:US
Mailing Address - Phone:803-433-8090
Mailing Address - Fax:
Practice Address - Street 1:17 EAST HOSPITAL STREET
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102
Practice Address - Country:US
Practice Address - Phone:803-433-8090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty