Provider Demographics
NPI:1568706091
Name:NORTH ORANGE FAMILY DENTISTRY, KYLE D. BOGAN, DDS, LLC
Entity Type:Organization
Organization Name:NORTH ORANGE FAMILY DENTISTRY, KYLE D. BOGAN, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-548-1800
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-21
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0227701223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty