Provider Demographics
NPI:1558447623
Name:BOGARD, ROBERT H (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:BOGARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1728
Mailing Address - Country:US
Mailing Address - Phone:207-439-2310
Mailing Address - Fax:
Practice Address - Street 1:23 WALKER ST
Practice Address - Street 2:
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904-1728
Practice Address - Country:US
Practice Address - Phone:207-439-2310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV26201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice