Provider Demographics
NPI:1093938243
Name:BOGER, LEO H (DDS)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:H
Last Name:BOGER
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 1:2074 FOREST AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4811
Mailing Address - Country:US
Mailing Address - Phone:408-286-3229
Mailing Address - Fax:
Practice Address - Street 1:2074 FOREST AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4811
Practice Address - Country:US
Practice Address - Phone:408-286-3229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA185241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice