Provider Demographics
NPI:1255462768
Name:BOZA, GLORIA MICHELLE (DMD)
Entity type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:MICHELLE
Last Name:BOZA
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 1:2602 W SLIGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-4342
Mailing Address - Country:US
Mailing Address - Phone:813-930-5604
Mailing Address - Fax:813-930-6038
Practice Address - Street 1:2602 W SLIGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-4342
Practice Address - Country:US
Practice Address - Phone:813-930-5604
Practice Address - Fax:813-930-6038
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN142621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice