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Individual

MR. WILLIAM G BOZALIS

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
DDS MS PC

Contact information

Practice address
3613 NW 56TH, SUITE 105 THREE CORPORATE PLAZA, OKLAHOMA CITY, OK 73112
(405) 946-2455
(405) 946-3445
Mailing address
3613 NW 56TH, SUITE 105 THREE CORPORATE PLAZA, OKLAHOMA CITY, OK 73112
(405) 946-2455
(405) 946-3445

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3672
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
446465286001
BLUE CROSS BLUE SHIELD
OK
Enumeration date
12/07/2005
Last updated
07/08/2007
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