Provider Demographics
NPI:1568624245
Name:BOGAN, KYLE D (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:D
Last Name:BOGAN
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 1:7325 GOODING BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-7086
Mailing Address - Country:US
Mailing Address - Phone:740-548-1800
Mailing Address - Fax:740-548-1804
Practice Address - Street 1:7325 GOODING BLVD
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7086
Practice Address - Country:US
Practice Address - Phone:740-548-1800
Practice Address - Fax:740-548-1804
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2019-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0227701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice