Provider Demographics
NPI:1447260625
Name:BOZZO, PAUL WADE (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:WADE
Last Name:BOZZO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:PAUL
Other - Middle Name:WADE
Other - Last Name:BOZZO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3710
Mailing Address - Country:US
Mailing Address - Phone:281-359-8302
Mailing Address - Fax:281-360-7708
Practice Address - Street 1:1 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3710
Practice Address - Country:US
Practice Address - Phone:281-359-8302
Practice Address - Fax:281-360-7708
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX144651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice