Healthcare Provider Details

I. General information

NPI: 1194639484
Provider Name (Legal Business Name): CHRISTOPHER ANTHONY BOGHDADY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 HARBOR BLVD STE G1
COSTA MESA CA
92626-2562
US

IV. Provider business mailing address

27882 HOMESTEAD RD
LAGUNA NIGUEL CA
92677-3763
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-6100
  • Fax:
Mailing address:
  • Phone: 949-910-3533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS113351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: