Provider Demographics
NPI:1386863066
Name:ALAN G BOGGIE DMD LLC
Entity Type:Organization
Organization Name:ALAN G BOGGIE DMD LLC
Other - Org Name:ALAN G BOGGIC DMD LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:GRAHAM
Authorized Official - Last Name:BOGGIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-574-0718
Mailing Address - Street 1:233 E BLACKSTOCK RD
Mailing Address - Street 2:STE A
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29301-2652
Mailing Address - Country:US
Mailing Address - Phone:864-574-0718
Mailing Address - Fax:864-574-6248
Practice Address - Street 1:233 E BLACKSTOCK RD
Practice Address - Street 2:STE A
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29301-2652
Practice Address - Country:US
Practice Address - Phone:864-574-0718
Practice Address - Fax:864-574-6248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty