Provider Demographics
NPI:1336492834
Name:BOGER-TRI DENTAL, P.L.L.C.
Entity Type:Organization
Organization Name:BOGER-TRI DENTAL, P.L.L.C.
Other - Org Name:MINNETONKA DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-474-7057
Mailing Address - Street 1:17909 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-4139
Mailing Address - Country:US
Mailing Address - Phone:952-474-7057
Mailing Address - Fax:
Practice Address - Street 1:17909 DELTON AVE
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55345-4139
Practice Address - Country:US
Practice Address - Phone:952-474-7057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty