Provider Demographics
NPI:1285857102
Name:BOGGESS, JAMES A (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:BOGGESS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2904 GREENBRIAR DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7430
Mailing Address - Country:US
Mailing Address - Phone:217-793-9550
Mailing Address - Fax:217-793-9587
Practice Address - Street 1:2904 GREENBRIAR DR
Practice Address - Street 2:SUITE B
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-7430
Practice Address - Country:US
Practice Address - Phone:217-793-9550
Practice Address - Fax:217-793-9587
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190226851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice