Provider Demographics
NPI:1700825056
Name:BOZENTKA, NEAL EDWARD (DMD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:EDWARD
Last Name:BOZENTKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 FAIRVIEW RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081-2334
Mailing Address - Country:US
Mailing Address - Phone:610-328-0773
Mailing Address - Fax:610-328-6859
Practice Address - Street 1:630 FAIRVIEW RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-2334
Practice Address - Country:US
Practice Address - Phone:610-328-0773
Practice Address - Fax:610-328-6859
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027359L1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU08539Medicare UPIN