Provider Demographics
NPI:1649622572
Name:BOZIC, ZACHARY DAVID (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:DAVID
Last Name:BOZIC
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8930 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2132
Mailing Address - Country:US
Mailing Address - Phone:317-271-6060
Mailing Address - Fax:
Practice Address - Street 1:8930 W 10TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46234-2132
Practice Address - Country:US
Practice Address - Phone:317-271-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-03
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012779A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry