Provider Demographics
NPI:1811538325
Name:BOGART, SUNDAY ELIZABETH-HELEN (RDH)
Entity Type:Individual
Prefix:
First Name:SUNDAY
Middle Name:ELIZABETH-HELEN
Last Name:BOGART
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4211 WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:DUNSMUIR
Mailing Address - State:CA
Mailing Address - Zip Code:96025-2059
Mailing Address - Country:US
Mailing Address - Phone:916-508-0712
Mailing Address - Fax:
Practice Address - Street 1:610 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DORRIS
Practice Address - State:CA
Practice Address - Zip Code:96023-9100
Practice Address - Country:US
Practice Address - Phone:916-508-0712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32918124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist