Provider Demographics
NPI:1174820880
Name:BOGIS, JOHN MANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MANUEL
Last Name:BOGIS
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 1:12 RANGELEY RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01890-2633
Mailing Address - Country:US
Mailing Address - Phone:781-248-6519
Mailing Address - Fax:
Practice Address - Street 1:179 LONGWOOD AVE
Practice Address - Street 2:FORSYTH HYGIENE CLINIC
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5804
Practice Address - Country:US
Practice Address - Phone:617-278-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist