Provider Demographics
NPI:1750802641
Name:BOCIAN, BRETT (DMD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:
Last Name:BOCIAN
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 1:9234 TX-1604
Mailing Address - Street 2:121 & 123
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249
Mailing Address - Country:US
Mailing Address - Phone:210-681-1121
Mailing Address - Fax:
Practice Address - Street 1:9234 TX-1604
Practice Address - Street 2:121 & 123
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249
Practice Address - Country:US
Practice Address - Phone:210-681-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-29
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019031183122300000X
TX338761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX33876OtherDENTAL LICENSE
TX1750802641OtherNPI