Provider Demographics
NPI:1144244187
Name:BOGART, DOUGLAS (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:
Last Name:BOGART
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 E GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34453-3210
Mailing Address - Country:US
Mailing Address - Phone:352-344-9500
Mailing Address - Fax:352-344-4398
Practice Address - Street 1:3581 E GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34453-3210
Practice Address - Country:US
Practice Address - Phone:352-344-9500
Practice Address - Fax:352-344-4398
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice