Healthcare Provider Details

I. General information

NPI: 1376450700
Provider Name (Legal Business Name): KATELYN BOGART DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38000 ANN ARBOR TRL
LIVONIA MI
48150-2453
US

IV. Provider business mailing address

220 ROEHRIG ST
TRENTON MI
48183-1252
US

V. Phone/Fax

Practice location:
  • Phone: 734-591-3636
  • Fax:
Mailing address:
  • Phone: 734-756-1732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901606031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: