Provider Demographics
NPI:1104262658
Name:IRENE BODJANAC BOZIR, D.D.S., INC.
Entity type:Organization
Organization Name:IRENE BODJANAC BOZIR, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZIR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-505-1588
Mailing Address - Street 1:2924 CAPAZO CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4407
Mailing Address - Country:US
Mailing Address - Phone:760-505-1588
Mailing Address - Fax:
Practice Address - Street 1:230 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4906
Practice Address - Country:US
Practice Address - Phone:760-738-9595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA426351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty