Provider Demographics
NPI:1164758199
Name:STEPHEN P. BOGER, DDS, PA
Entity Type:Organization
Organization Name:STEPHEN P. BOGER, DDS, PA
Other - Org Name:BOGER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BOGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:763-546-7707
Mailing Address - Street 1:2720 ANNAPOLIS CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441
Mailing Address - Country:US
Mailing Address - Phone:763-546-7707
Mailing Address - Fax:763-546-7713
Practice Address - Street 1:2720 ANNAPOLIS CIRCLE
Practice Address - Street 2:SUITE A
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441
Practice Address - Country:US
Practice Address - Phone:763-546-7707
Practice Address - Fax:763-546-7713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND8092122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty