Provider Demographics
NPI:1790803583
Name:NEAL BOZENTKA D.M. D
Entity Type:Organization
Organization Name:NEAL BOZENTKA D.M. D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-328-0773
Mailing Address - Street 1:700 SOUTH CHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SWARTHMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19081
Mailing Address - Country:US
Mailing Address - Phone:610-328-0773
Mailing Address - Fax:610-328-6859
Practice Address - Street 1:700 S CHESTER RD
Practice Address - Street 2:
Practice Address - City:SWARTHMORE
Practice Address - State:PA
Practice Address - Zip Code:19081-2224
Practice Address - Country:US
Practice Address - Phone:610-328-0773
Practice Address - Fax:610-328-6859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027359L1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial PathologyGroup - Single Specialty