Provider Demographics
NPI:1013155191
Name:THERESE M. BOGS, D.D.S., LTD.
Entity Type:Organization
Organization Name:THERESE M. BOGS, D.D.S., LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THERESE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOGS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-534-9700
Mailing Address - Street 1:26634 S WINFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MONEE
Mailing Address - State:IL
Mailing Address - Zip Code:60449-9220
Mailing Address - Country:US
Mailing Address - Phone:708-534-7818
Mailing Address - Fax:
Practice Address - Street 1:5601 W MONEE MANHATTAN RD STE 117
Practice Address - Street 2:
Practice Address - City:MONEE
Practice Address - State:IL
Practice Address - Zip Code:60449-8866
Practice Address - Country:US
Practice Address - Phone:708-534-9700
Practice Address - Fax:708-534-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-28
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-022073261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental