Provider Demographics
NPI:1639468226
Name:ZANG-BODIS, JOHN R (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:ZANG-BODIS
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
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
Is Sole Proprietor?:No
Enumeration Date:2011-04-04
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010192061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics