Provider Demographics
NPI:1720063225
Name:BOZALIS, WILLIAM G (DDS MS PC)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:G
Last Name:BOZALIS
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Gender:M
Credentials:DDS MS PC
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Mailing Address - Street 1:3613 NW 56TH
Mailing Address - Street 2:SUITE 105 THREE CORPORATE PLAZA
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112
Mailing Address - Country:US
Mailing Address - Phone:405-946-2455
Mailing Address - Fax:405-946-3445
Practice Address - Street 1:3613 NW 56TH
Practice Address - Street 2:SUITE 105 THREE CORPORATE PLAZA
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112
Practice Address - Country:US
Practice Address - Phone:405-946-2455
Practice Address - Fax:405-946-3445
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK36721223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK446465286001OtherBLUE CROSS BLUE SHIELD