Provider Demographics
NPI:1659522811
Name:BOZIR, IRENE BODJANAC (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:BODJANAC
Last Name:BOZIR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2924 CAPAZO CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4407
Mailing Address - Country:US
Mailing Address - Phone:760-505-1588
Mailing Address - Fax:
Practice Address - Street 1:230 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4906
Practice Address - Country:US
Practice Address - Phone:760-738-9595
Practice Address - Fax:760-738-9596
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42635122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist