Provider Demographics
NPI:1891911525
Name:BODZIOCH, GAIL E (DMD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:E
Last Name:BODZIOCH
Suffix:
Gender:F
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:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-0711
Mailing Address - Country:US
Mailing Address - Phone:860-563-1295
Mailing Address - Fax:860-563-9399
Practice Address - Street 1:412 CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-1834
Practice Address - Country:US
Practice Address - Phone:860-563-1294
Practice Address - Fax:860-563-1294
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist