Provider Demographics
NPI:1205281656
Name:BOZEK, WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:BOZEK
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 1:224 CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN TOP
Mailing Address - State:PA
Mailing Address - Zip Code:18707-1781
Mailing Address - Country:US
Mailing Address - Phone:570-479-2698
Mailing Address - Fax:
Practice Address - Street 1:3565 ROUTE 611 FL 2
Practice Address - Street 2:
Practice Address - City:BARTONSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18321-7800
Practice Address - Country:US
Practice Address - Phone:570-629-1142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PADS0420171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program