Provider Demographics
NPI:1295791879
Name:BOVENIZER, TODD S (DDD, MS)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:BOVENIZER
Suffix:
Gender:M
Credentials:DDD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 WELLESLEY TRADE LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-5669
Mailing Address - Country:US
Mailing Address - Phone:919-303-4557
Mailing Address - Fax:
Practice Address - Street 1:351 WELLESLEY TRADE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-5669
Practice Address - Country:US
Practice Address - Phone:919-303-4557
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC75551223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics