Provider Demographics
NPI:1669570214
Name:BOGARD, GEORGE A (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:A
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 1:7200 LAKEVIEW PKWY
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4205
Mailing Address - Country:US
Mailing Address - Phone:972-475-3429
Mailing Address - Fax:972-412-3954
Practice Address - Street 1:7200 LAKEVIEW PKWY
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-4205
Practice Address - Country:US
Practice Address - Phone:972-475-3429
Practice Address - Fax:972-412-3954
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX135911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice