Healthcare Provider Details

I. General information

NPI: 1568706091
Provider Name (Legal Business Name): NORTH ORANGE FAMILY DENTISTRY, KYLE D. BOGAN, DDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2012
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7325 GOODING BLVD
DELAWARE OH
43015-7086
US

IV. Provider business mailing address

7325 GOODING BLVD
DELAWARE OH
43015-7086
US

V. Phone/Fax

Practice location:
  • Phone: 740-548-1800
  • Fax: 740-548-1804
Mailing address:
  • Phone: 740-548-1800
  • Fax: 740-548-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-022770
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE DEAN BOGAN
Title or Position: OWNER/SOLE MEMBER
Credential: DDS
Phone: 740-548-1800