Provider Demographics
NPI:1053331231
Name:BOGARD, CURTIS DUANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:DUANE
Last Name:BOGARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 S AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-6350
Mailing Address - Country:US
Mailing Address - Phone:903-463-3443
Mailing Address - Fax:903-465-1134
Practice Address - Street 1:1127 S AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-6350
Practice Address - Country:US
Practice Address - Phone:903-463-3443
Practice Address - Fax:903-465-1134
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX120981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXD12098OtherBLUE CROSS BLUE SHIELD
TX825139OtherUNITED CONCORDIA PROVIDER